How to Order
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 Needs to insert refill order form with following info
* fields are mandatory 
  Prescription No: *
  Last Name: *
  First Name: *
  E-mail:
  Phone/Mobile: *
  Delivery/Pick Up: *
  Delivery Address: *
  Any Instruction to Pharmacist:
  Auto Refill: Yes No
Auto Refill is now available! Get your prescription sent to you regularly and never worry about requesting a refill again. Our friendly staff will remind you every month.