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Home > New Prescriptions / Existing Customers

New Prescriptions / Existing Customers

Please complete this form only if you are an existing client with a new prescription.

Personal Information

First Name Last Name
E-Mail

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 Ave, 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:
 

Method of Delivery

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

If we need to ship/deliver to a different address than the one
we have on file, please list it here:
Address
City State Zip

Other Information

Has any of your information changed? (address, phone, insurance, etc.) Yes No
If yes, please give us the updated information:

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

Enter any additional information you feel is necessary here: