your rx

NO UNCOMFORTABLE VISITS TO THE PHARMACY

our process

Process1

you

FILL OUT THIS FORM

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Process2

we

WORK WITH YOUR DOCTOR

Process3

we

CONTACT YOU FOR DELIVERY

what would you like to do?

patient details

First name*

Last name*

Email*

Phone*

DOB*

Preferred delivery method

Would you like us to provide a personalized nutrition depletion & supplements consultation?

Many medications affect key nutrients in your body, so it’s important to take the right supplements to replace them. Our pharmacists are happy to e-mail or call you with details on what supplements you should be taking with your medication to enhance health and minimize side effects.

prescription medication quote

Name(s) of medication needed*

Please provide a quote for:

Do you have a current prescription?

Do you need anything over the counter?

Comments/questions

patient details

First name*

Last name*

Email*

Phone*

DOB*

Preferred delivery method

Would you like us to provide a personalized nutrition depletion & supplements consultation?

Many medications affect key nutrients in your body, so it’s important to take the right supplements to replace them. Our pharmacists are happy to e-mail or call you with details on what supplements you should be taking with your medication to enhance health and minimize side effects.

refill

Name of medication*

Prescription number*

Okay to charge card on file?*

patient details

First name*

Last name*

Email*

Phone*

DOB*

Preferred delivery method

Would you like us to provide a personalized nutrition depletion & supplements consultation?

Many medications affect key nutrients in your body, so it’s important to take the right supplements to replace them. Our pharmacists are happy to e-mail or call you with details on what supplements you should be taking with your medication to enhance health and minimize side effects.

transfer prescription

Name of current pharmacy*

Current pharmacy phone*

Name(s) of prescription medications*

QUOTE MY RX
REFILL A RX ALREADY ON FILE
TRANSFER A RX FROM ANOTHER PHARMACY

have a general question?

CONTACT
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location

750 4th St. SW
Hickory, NC 28602

STATES WE SERVE:

NC, SC, VA, FL, GA

contact us

Toll Free: (877) 255-0094
Local: (828) 324-4115
Fax: (828) 322-7299

Mon–Fri: 9am–5:30pm

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