Patients

We help personal injury patients get their prescriptions quickly.

Get Started in 2 Simple Steps.

Receive Your Medications with ZERO Out-of-Pocket Costs

Step 1

Fill out the form below. We'll contact you soon.

"*" indicates required fields

Choose Your Pharmacy*

Patient's Name*

First Last

Patient's Date of Birth*

Patient's Phone*

Patient's Email*

Attorney Firm*

Attorney's Name*

First Last

Attorney's Phone*

Attorney's Email*

Date of Accident*

Is there a Case Manager?*

Yes

Case Manager's Name*

Name of Physician's Practice*

Physician's Name*

First Last

Comments

This field is for validation purposes and should be left unchanged.

Step 2

Pick Up Your Meds

— or —

Get them Delivered for FREE

After receiving your info, we'll contact you. Then, we'll schedule your FREE prescription delivery or pick-up from your chosen pharmacy.