Your Name:*

Your Email

Your Phone #:*

Prescription 1: Name or RX #*

Prescription 2: Name or RX #

Prescription 3: Name or RX #

Prescription 4: Name or RX #

Prescription 5: Name or RX #

Please select pick-up or delivery:*

Pick-UpDelivery

Which day would suit you best for pick-up or delivery?*

We are open Monday to Friday from 9AM - 6PM and Saturdays 9AM - 3PM.

Notes:

A Prime Care Pharmacy staff member will contact you if there are any issues completing your refill request.