RX Refill Request - Post Haste Pharmacy

Rx Refill Request

Fill out the form below to request a refill.
Looking to transfer your prescription? Select “Transfer Prescriptions” above.

"*" indicates required fields

Name*

First Last

Phone*

Please enter the Rx number located on the your prescription label.

Prescription #1*

Shipping and handling MAY apply (we ship for free to Life Extension customers)

Select Delivery Method

Pick Up Prescription

Mail My Prescription

When would you like to pickup your prescription?*

*Please allow one business day for processing

Please choose how you would like to pay :*

Charge My Card On File

Pay On Pickup (Not applicable for all prescriptions)

Enter the last 4 digits of the card on file*

Would you like your pharmacy to contact your doctor if your prescription needs authorization?*

Yes

This authorizes us to contact the prescribing physician if necessary.

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