Order refills in Burlington

Ready to order a refill for your prescription? Fill out the form below and submit it. Do you have questions? Call 262.763.8877.

Please note: If you’ve had problems ordering prescriptions online in the past, please try again. We have the glitch fixed now. Sorry for the inconvenience.

First Name*
Last Name*
Email*
Phone*
Message
Prescription Number 1*
Prescription Number 2
Prescription Number 3
Prescription Number 4
Prescription Number 5
Prescription Number 6
Prescription Number 7
Prescription Number 8
Prescription Number 9
Prescription Number 10
Prescription Number 11
Prescription Number 12
When would you like to pick up your refills?*
- Today AM
- Today PM
- Tomorrow AM
- Tomorrow PM
- More than 2 days
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Order Prescriptions Refills