Apply For Prescription – Prime Time Pharmacy

Apply for Prescription | Prime Time Pharmacy

At Prime Time Pharmacy, we are committed to making it easier for you to access the health products you need, including prescription medications for diabetes management, insulin solutions, and other health essentials. If you need a prescription to purchase from us, we are here to help. Follow the steps below to apply for a prescription through our pharmacy.

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Name

First

Last

Sex

Male
Female

Date Of Birth

Phone

Address

State

Zip Code

Past Medical Problems (e.g. Asthma - if none, type "none")

Current Medications (If none, Type "none")

Known Allergies (If none, type "none")

Known Ozempic, reaction

Medication Desired

Dosage Desired

Reason For Medication (Summarized)

Does The Patient Have Personal Or Family History Of thyroid Cancer?

Has the patient or a family member been diagnosed with Multiple Endocrine Neoplasia syndrome?

Has the patient ever had an allergic reaction to Ozempic, semaglutide, Rybelsus, or another GLP-1 receptor agonist medication?

Confirm Request and Agree to Terms

By clicking the "Submit Request" button, you indicate that you, as the patient or legal guardian of the patient, agree to the Terms of Service, Privacy Policy and Consent to Telehealth. After you submit your request, a licensed medical provider will review your information. You will be notified by email when that provider has reviewed your request and, if appropriate, made care recommendations.