Prescription Refills - Post Haste Pharmacy

Save time and money! Refill your prescriptions online and receive a $1.00 discount on each Rx!*

Patient Details
Name*
First Last
Email*
Phone
Prescription Details
Prescription #1
Prescription #2
Prescription #3
Prescription #4
Prescription #5
Prescription #6
Prescription #7
Additional Information
Would you like to*
- Pickup your Prescription
- Have the Prescription Mailed to you (**)
**Note: Shipping + Handling Will Apply
Would you like your pharmacy to contact your doctor if your prescription needs authorization?*
- Yes
- No
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Privacy*
- By using this form you agree with the storage and handling of your data by this website. *

*Discount applicable on cash pay prescriptions only. Not applicable on on prescriptions processed to insurance.

Patient Details