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Please find the option below that applies to you and click on the corresponding link to the right. When filling out the Online Form, please be sure to fill out the Member Information and Payment Options sections with each order. The Health History section is only required for your first order or as information changes. Please complete the other sections of the form as applicable.

• New Prescriptions - I have the prescription(s) in my possession
  
  
• New Prescriptions - I do not have the prescription(s) in my possession
  
  
• Refill Prescriptions - For existing prescriptions
  
  
• Refill and New Prescriptions - For existing prescriptions and placing a new prescription order