Users will automatically agree to the following upon the submission of this prescription form:
- I understand that if my prescription is eligible for this service then the original Prescription must be provided at the time of prescription pickup.
- I understand that not all prescriptions will be eligible for this service, a pharmacy team member will contact me if my prescription is not eligible (e.g. From out of country doctor. Medication that are not available/offered by the pharmacy. Prescription already expired/written over one year ago. Forgery).
- I understand that a pharmacy team member may contact me when my prescription is ready (wait-time may vary).
- By submitting this form, I am consenting to the collection and use of my personal information for the purpose of submitting my prescription to be filled by the Pharmacy I have selected. I understand that my prescription and personal information will reside at the pharmacy I have chosen.
Medical Conditions (Check all that applies)
Upload Your Prescription
We will email you a payment link for your presecription, a receipt and pickup/delivery method once we have processed your information.