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928.855.0106
1840 Mesquite Avenue
Suite E
Lake Havasu City, AZ 86403
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Refills

You can now request refills online. Requests are usually ready within one business day. If there is a problem regarding your refill, we will attempt to contact you with the e-mail address and/or phone number you provide below. Refills requested on weekends may require one extra business day to fill.

Please fill in all information so we can provide the best service possible. All information is strictly confidential and submitted via a secure connection.

First Name
M.I.
Last Name
Address Line 1
Address Line 2
City
State
Zip Code
E-mail Address
Phone
Alternate Phone
Bold = Required field
Prescription Number (1)
Medication / Prescription Name (1)
Prescription Number (2)
Medication / Prescription Name (2)
Prescription Number (3)
Medication / Prescription Name (3)
Prescription Number (4)
Medication / Prescription Name (4)
Prescription Number (5)
Medication / Prescription Name (5)
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