Refills For Current REV Clients

If you need a refill of your medication or supplies, please complete the form below.

-We will reply with an online Invoice or you can indicate ‘use my Card on File’ in Additional Info below

-Delivery is typically 2-3 business days, faster in the NYC Metro area

-Most medications arrive ‘on ice’ and need to be refrigerated upon receipt - let us know if a certain delivery date isn’t good for you in the Additional Info section below

If you have questions please email us at hello@revformen.com, call us (917) 397-4738

Name *
Name
Date of Birth *
Date of Birth