NOTE:
In order to insure that your order has been received by Clinic Pharmacy.... Expect a confirmation e-mail within 2 hours during business hours or by 10:30 a.m. for overnight/weekend orders.
If you do not receive a confirmation e-mail...
please call 608-786-2828.

Name:
*E-mail:
*E-mail:	(for confirmation)

Enter your prescription number(s) OR drug name and patients name in the following fields:

Rx Name/Number: Patient:
Rx Name/Number: Patient:
Rx Name/Number: Patient:
Rx Name/Number: Patient:
Rx Name/Number: Patient:
Rx Name/Number: Patient:
Rx Name/Number: Patient:

Would you like us to add any Over the Counter (OTC) medications to your order? (Tylenol, aspirin, iron pills etc...)
Yes
No

If yes, please list:

Pick up
Delivery