Prescription Refill Request
Please fill out the following form and one of our Super Tech's will let you know when its ready or contact you with any questions.
<script><!-- [et_pb_line_break_holder] -->jQuery( document ).ready(function() {<!-- [et_pb_line_break_holder] --> jQuery('.presc').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').show();<!-- [et_pb_line_break_holder] --> jQuery('.input#et_pb_contact_drug_1').focus(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.drug').show();<!-- [et_pb_line_break_holder] --> }).blur(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.drug').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').show();<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> jQuery('.input#et_pb_contact_concentration_1').focus(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.conc').show();<!-- [et_pb_line_break_holder] --> }).blur(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.conc').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').show();<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] --> jQuery('.input#et_pb_contact_dose_1').focus(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.dose').show();<!-- [et_pb_line_break_holder] --> }).blur(function(){<!-- [et_pb_line_break_holder] --> jQuery('.presc.dose').hide();<!-- [et_pb_line_break_holder] --> jQuery('.presc.main_img').show();<!-- [et_pb_line_break_holder] --> });<!-- [et_pb_line_break_holder] -->});<!-- [et_pb_line_break_holder] --></script>