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Allergy Prescription Renewal

To renew your allergy prescription, we require an authorized prescription (Rx) from your physician’s office.
Please note: some physicians may request an in-person visit before approving a renewal.

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How to Renew

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You have two options:

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Option 1: Download and email or print the Renewal Form

  • Rx Renewal Form ← Download the form by clicking this link.

  • Print and bring the form to your physician’s office OR email the form directly to their office.

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Option 2: Submit Online

Fill out the form below and we’ll forward it to your chosen clinic on your behalf.

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Need Help?

If you have any questions or concerns, please contact us.

Rx Renewal Request

Date of Birth
Year
Month
Day

To expedite your prescription renewal, please contact your physician’s office and request that they process your allergy renewal. You can assist by emailing the downloadable PDF form to their office or dropping it off in person. Upon submitting this form, Western Allergy will fax your physician’s office to request that a renewal be authorized.

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