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Home > New Prescriptions

New Prescriptions

Please complete the following as thoroughly as possible to expedite your request:
(Note: if you are an existing client with a new prescription click here.)

all required fields are marked - *

Personal Information

First name* Last name*
Address*
City* State* Zip*
Daytime Phone Evening Phone
E-Mail*
DOB*
Sex Male Female
Are you allergic to any medications? Yes No
If yes, please list the medications here:

If we need to contact you, what is the best way to reach you?
E-Mail Daytime Phone Evening Phone Mail

Insurance Information

Insurance Company
ID # Group #
Insurance Company
Phone #

Prescribing Physician Information

Physician name Office Phone

Prescription Information

You can send us the prescription information one of the following ways:
Mail - you can mail the original prescription to us at:
-------- B&B Pharmacy 10244 Rosecrans Av, Bellflower CA 90706 --------
Fax - you can fax the prescription to us at:
-------------- 800-705-8964 --------------
Doctor - your doctor can call the prescription in at:
------------- 800-231-8905 -------------
Have us call - we can call your doctor to get the prescription information.
(Make sure you have provided the doctor's office phone number above)

Enter the name of the medication here:
Enter the name of the medication here:
Enter the name of the medication here:
Enter the name of the medication here:
Enter the name of the medication here:

Method of Delivery

Please select the method of delivery for your prescription(s):
Free shipping by UPS or FedEx
Free citywide delivery in the Bellflower, Downey Metro Area
No delivery, prescriptions will be picked up at pharmacy

If we need to ship/deliver to a different address than the one
you entered above, please list it here:
Address
City State Zip

Additional Information

Enter any additional information you feel is necessary here: