Health Dimensions Pharmacy, Inc.

Health Dimensions, Inc.
39303 Country Club Dr., Suite A-26
Farmington Hills, MI 48331

Phone: 248.489.1573 or, 800.836.2303
Fax: 248.489.1586
Email: info@healthdimensionspharmacy.com

Refill your prescription quickly and easily by email! Simply fill out the form below. Items with an * must be completed for your order to go through properly.

Patient Name:*
Prescription #s:


Refill for:	1 month 2 months 3 months
Phone Number on File:
Daytime Phone:*
Email Address:*

	Notes or Special Instructions:

Delivery Methods:
Pickup: Ship:	Note: Orders typically available for pickup in 24 hours US Mail Priority ($5.60, 2-3 business days) UPS Ground ($7.95, 1-2 business days) Other delivery options available, prices vary, please contact us for more information (248-489-1573).

Note:
Shipping charges will automatically be charged to your account based upon shipping method selected. If no method is selected, prescription will be sent via US Mail.

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