Thank you for requesting your refill(s) via our convenient and secure online form. Please fill out all the fields below. Once you submit, please be on the lookout for a call and/or text from a friendly Mandell's Patient Care Coordinator who will help you finalize your delivery.  Your refill cannot ship until you finalize your delivery.
Have you had any changes to medical conditions or diagnosis since your last fill? *
Have you made any changes to the medications or vitamins you currently take (if any), prescribed or over the counter? *
Have there been any changes to your contact information and/or your emergency contact? *
Do you need trigger shot *(HCG, Ovidrel, Leuprolide PFS) at this time? *
I also need the following: *
Next steps 
A Patient Care Coordinator will process your order as soon as possible but we will need to speak to you in order to schedule your shipment. Please watch for a text message from Mandell's, which will include directions on how to finalize your order. *
Please click submit to finalize your request.