Prescription Refill Form


First Name *

Last Name *

Daytime Phone *

Email Address *

Address *

City *

State *

Zip Code *

Would you like your medication(s) shipped? NOTE: We do not ship to a PO Box.

Shipping Address

Shipping City

Shipping State

Shipping Zip Code

Prescription Numbers

1st Refill *

2nd Refill

3rd Refill

4th Refill

5th Refill

Do you need all injection supplies for all medications?

Please specify what injection supplies you need.

Comments or Special Instructions


States We Are Licensed In

We are constantly striving to add more states to be licensed in.


Drug Crafters is committed to maximum value for prescribers and patients through top quality products, elite customer service, and exceptional prices.

Customer Care

Our elite team of pharmacists and compounding technicians are dedicated to making your experience with Drug Crafters quick and easy. We pride ourselves on excellent customer service and are committed to continual improvement so that every prescriber and patient gets exactly what they deserve.


If we don’t already have it in our formulary of more than 8,000 compounded prescriptions, our pharmacists will formulate medications that are customized for the unique needs of prescribers and their patients.


We prepare your prescription in our state-of-the-art pharmacy that includes an independently certified clean room, laminar airflow hoods, and a commitment to the strict requirements of Chapter <797> of the U.S. Pharmacopoeia for compounding non-sterile and sterile preparations.