Rx RefillPlease fill out the information below. Client Name * First Name Last Name Email * Phone * (###) ### #### Text Area * Medication Checkbox Shipped- Add $4.00 Clinic Pickup Shipping Address - Not required for Clinic Pickup. Address 1 Address 2 City State/Province Zip/Postal Code Country Thank you!Once your refill is approved, you will receive an E-Mail with a payment link. Approval may take 6-8 hours. Thank you.