Prescription Request Page

Request your prescription online by filling out the form completely below. Please allow 48 to 72 hours for your request to be reviewed, approved and sent. 

For more information or to make a prescription request by phone please contact our office at (317) 644-3461 at our regular business hours Monday - Friday (8 am to 12 pm), (1 pm to 5 pm)

Your personal information is for our Clinic only and will be used solely to contact you.
We will not give away or sell your information to anyone.