First Name:
Last Name:
Date of birth:
Phone Number: (XXX-XXX-XXXX)
(Please use the number we have on file for you)
Email: (Example: name@emailbox.com)
Account Number: (optional)
Please estimate how many days of medication you have remaining and select from below:
To update your account information, please click here: https://www.usmed.com/current-patients/change/
Thank you for reordering through US MED®.
Your order will be processed within the next 48 hours. You will receive a confirmation email. If you don't receive the confirmation email within 48 hours, please contact our Customer Care Team at 1-866-723-6958.
Sorry, we couldn't process your request at this time, please call us at 1-866-723-6958 to place your request.