Prescription Services

Prescription Request

Choose an option below — transfer your prescription from another pharmacy, or have one of our pharmacists contact your doctor directly.

How Can We Help?

Select a Request Type

Pick the option that best describes what you need and we'll walk you through the rest.

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Transfer from Another Pharmacy

Moving to Brand Direct Health®? We'll contact your current pharmacy and transfer your prescription on your behalf.

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Request a Pharmacist to Call Your Doctor

Need a new or updated prescription? One of our pharmacists will contact your doctor's office directly on your behalf.

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Patient Information

Enter your personal information so we can locate and set up your account.

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

Shipping Address

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Prescription Information

Enter the details of the medication you'd like transferred.

Medication Name *

Directions / Sig Enter the directions as written on your prescription or medication label.

Prescriber Name

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Current Pharmacy

Provide the pharmacy where your prescription is currently on file.

Pharmacy Name *

Pharmacy Phone Number * We'll contact your pharmacy directly to initiate the transfer.

HIPAA Acknowledgment & Consent: By submitting this form, you acknowledge and agree that the information you provide may include protected health information (PHI). You consent to its use and disclosure for the purposes of responding to your inquiry, providing services, and carrying out healthcare operations in accordance with our privacy policy. Do not submit confidential or sensitive information unless you consent to this use.

Our team will contact your pharmacy and follow up with you within one business day.
Questions? Call us at 866-331-6440, Mon–Fri 8 AM–8 PM ET.

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Patient Information

Enter your personal information so we can reach you with an update.

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address

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Doctor / Prescriber Information

Provide your doctor's contact details so our pharmacist can reach them directly.

Doctor's Name *

Doctor's Office Phone *

Practice / Clinic Name (optional)

Doctor's Fax Number (optional) Providing a fax number can help us send a written prescription request.

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Medication & Request Details

Tell us what medication you need and any relevant details for our pharmacist.

Medication Name *

Reason for Request / Additional Notes Include any details that will help our pharmacist communicate effectively with your doctor.

Best Time to Contact You

Preferred Contact Method

Our pharmacist will contact your doctor's office within one business day.
Questions? Call us at 866-331-6440, Mon–Fri 8 AM–8 PM ET.

Need Help Right Away?

Our team is available by phone or text Monday through Friday, 8 AM to 8 PM ET.

📞 Call 866-331-6440 Contact Us