Pharmacist Consultations Anthony’s Pharmacy is managed by a pharmacist with over 22 years of experience. If you wish to have a private consultation, please fill out the request form below. Submit Your Referrals Free Delivery Service Client Satisfaction Survey Telemedicine Complete the form below to transfer your prescription to Anthony’s Pharmacy. First Name Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Colombia Delaware Florida Georgia Idaho Hawaii Illinois Iowa Indiana Kansas Kentucky Louisiana Maine Maryland Michigan Massachusetts Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip/Postal Code Email Address How do you prefer to be contacted? Phone Fax Email Fax Phone Best time to call Anytime Morning at Home Morning at Work Afternoon at Home Afternoon at Work Evening at Home Evening at Work Preffered Date Preferred Time Current Medical Conditions Do you take any Food/Vitamin supplements? If so, what? Do you smoke? If yes, how many per day? Exercise (what types and how often) How well do you sleep? Good Average Restless Poor Average hours of sleep per night Send