To initiate the refill process, complete the form below.

The form is only for refills of existing prescriptions. If you are a new patient, please contact us for assistance at 800-660-4283.

Before your order is shipped a Patient Care Coordinator will contact you via phone to verify the information submitted and to obtain payment information. If you need your medications within 24 hours or delivered on a Saturday, please contact us directly at 800-660-4283 and select option 6. There are no Sunday deliveries.

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Patient Information

Allergies

Do you have any other allergies or have you developed any since your last order?

Cycle type

Shipping Information







Refill Request

Medication Quantity
+ To add another row, please complete medication and quantity. To remove a row, please click the minus (−) button.

Additional info

Do you need any additional supplies with your order?
If you need any supply, please specify.

Delivery Date Request

Our Shipping Policies.

  • Your refrigerated medication will be in an insulated foil bag with an ice pack; remove your medication from that bag & place in the refrigerator.
  • FedEx or UPS Carrier: Delivery is between 8AM and 5PM. If you live in a remote area, packages will be delivered by the end of the business day.
  • If you would like an estimated price quote please call us at (800)660-4283. A pharmacist will confirm and you will receive detailed information in your package.
  • Freedom Fertility adheres to a strict no return policy. Once medication is dispensed from our pharmacy, it cannot be returned or cancelled for any reason.
  • Open immediately and report any discrepancies within 24 hours.

Please, confirm you have read our shipping policies before submitting your order


Dear Patient, you have the right to know about proper use of your medications and its effects. If you need more information please ask a Pharmacist.