Wear Drug, Inc.

e-Refills

Fill out the information below and Wear Drug will refill the prescription(s) you specify below. Please make sure you specify the delivery method. If there is anything we should know or any extra comments you would like to include, please enter that information in the "Comment" box.

Name*:
E-Mail Address*:
Phone*:
Rx Number(s)*:




Delivery Method*:
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