Online Prescription Refills

Refills are available by:
• Calling our pharmacy during normal business hours
• Calling after hours and leaving a request on our voicemail
• Filling out the form below

You can use this form for prescription refills. This form is only intended for use if your shipping and billing information is the same as your previous order. If you need to make a change to either of those, please contact the pharmacy at (804) 717-5000 or toll free (888) 384-5470.

If you have a new prescription from your physician or veterinarian for a compounded medication that you would like to fill you can mail the prescription to:

Rx3 Compounding Pharmacy - 12230 Ironbridge Rd, Suite C - Chester, VA 23831
Make sure you include your contact information and insurance information

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Fax you prescription to the pharmacy at (804) 717-8300 or toll free (888) 384-5471.
Make sure you include contact information and insurance information.

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Your Physician or Veterinarian can call in your prescription to the pharmacy at
(804) 717-5000 or toll free at (888) 384-5470

Once we have your prescription we will contact you with the price of your prescription, or you can call us at (804) 717-5000 or toll free (888) 384-5470.

General Information:
First Name:	*
Last Name:	*
Phone:	*
Email:

Prescriptions:
Rx #:	*
Rx #:
Rx #:
Rx #:
Rx #:

Delivery Information:
Method:	*
Address:
City:
State:
Zip:

Comments or Special Requests:


* - Please complete before submitting