• Write Your Prescription Below

  • Please fill in all fields, "Your Name" may be left anonymous if you prefer.

    To purchase one or more generic recipient prescriptions, please write "blank" in "recipient name" fields. The message will be the same for each prescription in the order, great for random acts of kindness! Please do not leave message field blank.

    • $4
    • $8.50
    Total Price

  • *Debit/Credit card accepted through Paypal or Stripe. After submitting form you will be redirected to payment method you selected. Please complete payment to prevent your prescription from being delayed!

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