Please call us, email us using our web form on the below, or fax us at (212) 941-5977. Please give all details about dose and your pharmacy name and phone number (and pharmacy fax number and email address if it is available). Although we try to handle all requests on the same day, please allow two business days so that you do not run out of your medication.

Also, please be clear about whether you need a 1, 2, or 3 month refill, whichever your insurance requires.

Name* Date Of Birth * Home Number Cell Number * Email Address * Name of Medication* Dosage* Directions* Allergies* Are You Pregnant?* Yes No Are You Breast Feeding?* Yes No Amount Needed?* (Check with your insurance) One Month Supply Three Month Supply Last menstrual period* Name of pharmacy * Phone number/Fax of pharmacy* Check here if you need a written prescription mailed to you for your mail order pharmacy. Also all controlled medication prescriptions cannot be called in, and will be mailed directly to you.     Questions & Comments   Please enter in the characters shown below. Having a hard time reading? Move your mouse over the speaker...

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