This form allows you to repeat a prescription with Pharmex Direct. Your prescription must be on file with our pharmacy and have repeats available to be dispensed. We will contact you if there is any delay.

(If this is your first prescription from Pharmex Direct, please enroll here.)
If you would like to transfer an existing prescription with repeats from another pharmacy, please contact us.


Your Name (required)

Daytime Telephone Number (required)

Email Address (required)

Prescription number(s) and/or medication name:

  Prescription Number Prescription Name
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5.

If there have been any changes to your medication, or your delivery instructions, please let us know in the comment field below:

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