Prescription Refills

First Name *

Last Name *

Phone Number *

Email Address *

Total number of prescriptions requested *

(insurance only covers one month at a time, please call us directly if you are needing more than one month)

Prescription name *

Prescription number

(if available)

Prescription name

Prescription number

Prescription name

Prescription number

Prescription name

Prescription number

Is this a Pick up/mail/delivery? *

Pick Up

Delivery

Mail

-we deliver ONLY to the 93108 zip code) $4

-Fed Ex (Overnight:Priority/Standard, 2 day, signature/no signature, Sat.arrival

- check FedEx website for approximate prices in your area)

Would you like us to call when ready? *

Yes

Comments/Additional information

What is the best number to reach you?

Please allow 24-48 hours for compounded prescriptions.
We will fax your Doctor on prescriptions without refills. Please allow at least 24-48 hours for MD to respond to us, and please notify us of any changes in doctors.
Insurance may only cover 1 month at a time, please call us directly if you need more than one month.
Mailed Prescriptions will take 2-5 business days for delivery, in addition to the time needed to prepare your RX.
If this is a new prescription, stop, and have your doctor contact our pharmacist or bring in the original prescription.
If you are a new patient, or this is a prescription transfer, please contact us directly at (805)969-2284 or toll free at (800)796-2452.
Any changes in address, insurance or credit card, you can submit it to the comments section or call us directly.