New Customer Form

  • Drop files here or
      If this is a new prescription, please attach the picture here. You can upload more than one prescription.
    • Date when this medication was prescribed to you by your doctor.
    • Drop files here or
        Please attach the picture of your drug coverage card(s) for billing.
      • Courier verified two-hour delivery window will be sent to you on the day of delivery.
      • e.g. leave with Joan at reception, place in mail box, call when at entrance,