855-633-7977   |   GRP: LiveDocOnCall

Fax: 862-242-5649

Prescription Upload

A valid prescription from your doctor is required to place an order.

Step 1. Price your brand-name medication.

Step 2. Complete your order online or call 855-633-7977 to order/refill with Customer Service.

Step 3. Your medications ship directly to you.

If you prefer to place your order via a PDF form, download and complete our Mail Order Form.


Your Name: *  

Your Email: *  

Your Phone:       (999-999-9999)

Your Prescription: (Please select only jpg, jpeg, jpe, png, bmp, or pdf files.) *  

Enter Security Code: *  



If you prefer, send your prescription via FAX: 862-242-5649 or email: ScriptUpload@MedAffordGlobal.com


Note: We do not share or sell your information to third parties.