Shop Here Now

Customer Service

We can process new refill requests in about 72 hours. If you would like to be on our auto refill schedule, please notify us. Our auto-refill feature allows you to receive your prescription automatically each month or when they are due. Please fill out the following form to request a refill, and we will be in touch with you shortly: all required fields are marked - * Personal Information First Name* Last Name* E-Mail* Prescriptions to be Refilled/Transferred (You may enter the prescription name or the number printed on the label) #01 #02 #03 #04 #05 #06 #07 #08 #09 #10 #11 #12 #13 #14 #15 Method of Delivery Please select the method of delivery for your prescription(s): shipping by US mail regular or priority or FedEx Free citywide delivery in the Bellflower, Downey 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 Transfer Information Complete this section only if you are transferring a prescription from another pharmacy. Prescriptions must have refills available in order to be transferred. (If they do not, please go to the new prescription request form.) Name of pharmacy Phone # Your 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 # Additional Information Enter any additional information you feel is necessary here: