The pharmacy can accept only original prescription drug orders from patients, and that faxed prescriptions can be accepted only from the prescribing practitioners.

Please provide the following information to Request a New Prescription:

Your Information *=Required Information

Prescription Request

Your Insurance Information

Your Physician Information

By checking this box, I am acknowledging that I understand that the information entered above may constitute protected health information, and that by submitting this information, I am consenting to allow Quick Care Pharmacy Inc. to use the information to facilitate my treatment and care in accordance with Linden Care LLC’s Privacy Policy, including, but not limited to, verifying prescription coverage, contacting the patient to confirm enrollment information, and obtaining prescription and other relevant health information from the physician.