Request a Medication Refill

Request a Medication Refill

Refills are usually sent a few days before your current supply runs out. If you still have more than a week’s supply of medication, please wait before submitting a refill request. Note that requesting a refill will renew your monthly or 90-day subscription fee.
Legal Name*

First NameLast Name
Date of Birth (mm/dd/yyyy)*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number

Medication Details
Pharmacy Details: To ensure your medication is sent to the correct location, please let us know where you'd like your refill sent:*

Same as previous pharmacyMy pharmacy has changed (Please provide the new pharmacy's phone number on the next page.)
Please provide the new pharmacy's phone number below.*
Please enter a valid phone number

Thank you! Your refill request has been received and will be processed within 24 business hours. If you have any questions or concerns, please return to this webpage and follow the instructions to inquire about any of the following:
- Medication Management
  - Request a Medication Refill
  - Request a Dose Increase
  - Request a Dose Decrease
  - Switch to a New Medication
  - Report Side Effects
- Appointments
  - Request a Virtual Appointment
  - Reschedule or Cancel an Appointment
- Pharmacy Support
  - Update Pharmacy Information
  - Request Prior Authorization
- Billing & Insurance Reimbursement
  - Pay a Bill
  - Billing Questions
  - Request Invoice to Submit to Your Health Insurance
- Other Requests
  - General Admin Questions

Choose Your Prescription Duration*

30 days

$45.00

90 daysIf your last prescription was sent within the past 7 days (including weekends), we will issue a 25% partial refund to account for the adjustment within 2 business days. Please note, it may take 7-14 business days for the refund to appear on your credit card statement.

$120.00

Enter coupon

Total

$0.00

Credit Card Details
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Credit Card Number	Security Code
Card Expiration

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Request a Medication Refill

Medication Details