Refill Form, Physicians Preference RX

When inputting your Rx numbers, only include numeric characters (do not include “n” or “r”)

If you don’t have your prescription number, please call the pharmacy, 281-828-9088.

Please use the NOTES box to specify quantity requested, shipping address, and credit card information (card number and expiration date). With the new system, we WILL need your payment information again.