Wear Drug, Inc.

Auto Refill Program

Tired of forgetting to call in your prescription or going to the pharmacy and realizing you are out of refills? Don't worry anymore! Wear Drug is pleased to announce its new Auto Refill Program. Just fill in the information below, and we will automatically fill your prescription a few days before you run out (we will also call your physician if you are out of refills). This way you do not have to worry about calling it in or not having refills. Simply come to Wear Drug and your prescription will be ready for you.

By filling out the information below, you will no longer have to call us to fill your prescriptions. They will automatically be filled for you and ready when you need them. To sign up for Wear Drug's Auto Refill Program, please submit the information below. Wear Drug will take care of the rest!

Name*:
Date of Birth*:
E-Mail Address*:
Phone*:
Comments:
	* denotes required information.
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Wear Drug • 408 Walnut St., Suite B (inside County Market) • Carthage, IL • 217-357-WEAR • www.weardrug.com