Refills

Custom RX

Refills

You can request up to 3 refills using this form. Please let us know if you have any questions.

    Patient's Name (required)

    Your Email (required)

    Phone (required)

    Patient Address (required)

    City (required)

    State (required)

    Zip (required)

    Prescription No. 1(required)

    Prescription No. 2

    Prescription No. 3

    Last 4 Numbers of Credit Card (required)

    Comments or Questions

    Phone

    (800) 226-7094

    Email

    RX@CSRX.US

    Address

    27732 Cashford Circle
    Wesley Chapel, Fl 33544