RX REFILLREQUEST GET STARTED First Name Last Name Email Address Phone Number Street Address City State Zip Code Date of Birth Last 4 Digits of Card on File Weight (in pounds/lbs) Height (in inches) How are you feeling? Prescription Requesting Refilled? Quantity Requested (How Many)? Do you need labs? Yes No Would you like us to verify your refill by phone? Yes No *The Basic Panel consists of CBC, CMP, Lipid Panel, TSH, PSA/HCG, Estradiol and Testosterone. If you are planning on taking GH, you need an additional IGF-1. We can send you a lab order. For a fast, easy way to see your labs or make lab appointments, create a LabCorp account through the link below: https://patient.labcorp.com/ Send
