This form will be emailed to the pharmasist with a confirmation copy being sent to your email address. If you have any questions for concerns, please call us at 863-940-4733.

The astrics * indicate fields that must be filled out.

  • PATIENT INFORMATION:

  • Medical History

  • PRESCRIPTION DETAILS:

  • PICK-UP SCHEDULE :

  • Should be Empty:
When I first walked into the pharmacy, I was so impressed with how clean and organized it was. The pharmacist was very knowledgeable and willing to provide further assistance when needed. I love the one-on-one interaction I get from the pharmacist in compares to how I'm treated at the big chain stores.
Ms. Jessica

Talk about caring and compassionate. The pharmacist takes his time to explain my medication to me and how to best deal with possible side effects. Excellent Service!
John. T

I remember one time when I arrived just one minute before the pharmacy closed. I was not rushed out the store. They still took their time to help me. I really appreciate them.
Mary. Valdez

I like the fact that they know me by name when I step foot in their shop. It makes me feel special and I feel like they really care about me.
Susan :

I was happy to know that there was a pharmacy store close to my home because of my disability. When I call them, I always get a friendly voice with accurate information. Their delivery service was also a plus for me. Switching stores was a no-brainer for me. You guys are really supreme.
Mrs. Eleanor Franklin