Prescription Request

Use this form to request your prescriptions online. We will send it to you.
Since the law requires physician-patient contact, you can pick up your prescription at the practice the next day.
Unfortunately, it is not possible to send the prescription by mail.

Please provide us with all the necessary information when you place your order.
The fields marked with * are obligatory.

Name *
Medication *
Active ingredient dosage *
Package size *