Prescription Refills

Please include the PATIENT'S NAME below.
Please note that FedEx will not ship to a P.O. Box, the address needs to be a physical address. FedEx Next Day Air delivery does not include Saturday delivery. Refrigerated items require special shipping.

We accept American Express, Visa, MasterCard and Discover (please call 1-800-227-2627 to provide a credit card number or we will use the card from your last order).
** When we process this refill we will use the same credit card we used on your previous order. **
Please do NOT include credit card information when completing this Secure Online Refill Form.

* First Name:
* Last Name:
* Shipping Address:
Suite/Apartment No.:
* City:
* State:
* Zip Code:
Country:
* Your Email Address:
* Phone (In case we have any questions about your order):
Billing Address (if different from above):
Billing City:
Billing State:
Billing Zip:
First RX#:
First RX Quantity(Specify # of capsules, ml, troches, vials, grams, etc... for all RX#'s provided):
Second RX#:
Second RX Quantity:
Third RX#:
Third RX Quantity:
Four RX#:
Four RX Quantity:
Five RX#:
Five RX Quantity:
Six RX#:
Six RX Quantity:
Seven RX#:
Seven RX Quantity:
Eight RX#:
Eight RX Quantity:
Nine RX#:
Nine RX Quantity:
* Select FedEx Delevery Type:
If you are in Alabama and would like your package shipped via USPS?

Yes

No
Call Wellness at 800-227-2627 to provide credit card number. Please do NOT include credit card information when completing this Secure Online Refill Form.
If for pickup, When would you like to pick up?
Special Instructions (list any known drug allergies here):

* Required Field