Refer a patient

For prescribers and for patients whose prescriber has not worked with us yet. Tell us who the patient is and which practice is prescribing, and a pharmacist will contact the office to arrange the prescription.

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Nothing you enter here will be saved. To refer a patient now, call the pharmacy toll-free at 833-990-7873. For a medical emergency, call 911.

Patient

Who the prescription is for. We use these details only to coordinate the prescription and to contact the patient the way they prefer.

First name

Last name

Date of birth

State

Email address

Phone number

10 digit US number.

How may we contact the patient?

Choose every option that is fine.

Text messagePhone callEmail

Prescriber

The practice we should coordinate with. A pharmacist will contact the office to confirm the prescription.

Prescriber first name

Prescriber last name

Practice name

Practice email

Practice phone(optional)

Prescriber NPI(optional)

10 digits. Helps us match the prescription quickly.

Request

Optional. Anything that helps a pharmacist prepare for the call.

Medication of interest(optional)

Message(optional)

Do not include diagnoses or medical history here; share those with the pharmacist by phone.

Required so we can contact the patient and the practice about this request.

I agree to the privacy policy and consent to be contacted about this referral.Read the privacy policy and the notice of privacy practices (both open in a new tab).

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Refer a patient

Patient

Prescriber

Request

Consent