Online Order Form

Complete the form below for existing prescriptions of:

  • Allergy vials
  • Dexacort spray
  • Sinus irrigations

We will notify you when the item is ready for pick up. If you have not been previously prescribed these items, please do not fill out this form. Contact our office or make an appointment for further information. Our office number is 205-838-3755.

  • NOTE: This is not for medication refills other than those listed above.

  • Date Format: MM slash DD slash YYYY