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Refill 2023

THE VIKING OFFICE WILL RECEIVE AND EVALUATE YOUR REFILL REQUEST. IF APPROVED, THE PAYMENT INFORMATION SPECIFIED WILL BE CHARGED AND THE ORDER PROCESSED AND SUBMITTED TO THE PHARMACY.

MM slash DD slash YYYY
Email(Required)
MM slash DD slash YYYY
Name(Required)
Your Address(Required)
***We cannot ship to a PO Box - we need an actual street address in order to ship your medication. ***
Is your shipping address the same as billing address? A
***We cannot ship to a PO Box - we need an actual street address in order to ship your medication. ***
Shipping Address
***We can only ship to your residential address. We cannot ship to a PO Box - we need an actual street address in order to ship your medication. ***
Note: If a medication is outside of your already approved protocol you will need to schedule a consultation before we can send any new medication. ALSO: It is required that your lab results be less than 6 months old at all times. Please schedule labs prior to refill order if needed!
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