Fertility Medication Refills

Refilling your prescriptions has never been easier! Just enter your prescription information in the fields below.

"*" indicates required fields

Choose a location to have your medications refilled at:*

Millard (12741 Q St)

Lincoln (808 N 27th St)

Please have my medication ready by:*

Would you like notified when your refill is ready?*

YES

Delivery method:*

Mail

In-store pick-up

Personal Information

Name*

First Last

Date of Birth*

Phone*

Email*

Medication

Medication Selections

Crinone 8%

Endometrin

Follistim 300

Follistim 600

Follistim 900

Ganirelix 250mcg

Menopur 75 Units

Pregnyl

Progesterone in Oil

Medication Quantities

Please indicate the quantity desired for each of the medications selected above.

Crinone 8%*

Endometrin*

Follistim 300*

Follistim 600*

Follistim 900*

Ganirelix 250mcg*

Menopur 75 Units*

Pregnyl*

Progesterone in Oil*

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Comments

What is the answer to this equation: Five plus ten equals?*

Additional Comments / Special Instructions

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Phone

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Fertility Medication Refills

Personal Information

Medication

Medication Quantities

Comments

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Personal Information

Medication

Medication Quantities

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