Step 1 - MyRx Online Access Alternate Text
Step 2 - Personal Information Alternate Text
Step 3 - Terms of Agreement Alternate Text

MyRx Online Access

MyRx Online Access allows you to review and update your personal information and MyRx Services using your username and password. Registration only takes a few minutes and once complete, you are ready to place your order.

Password (case sensitive and must be at least 6 characters)
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Confirm Password
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Security Question
Security Answer

My Personal Information

Our Team needs this information so we can help you get the right medication and health information conveniently and confidentially.

If you'd like assistance completing this form, call us at 1-877-812-MyRx.

Personal Information

Last Name
First Name, Initial
Date of Birth
Male Female
Primary Phone
Secondary Phone (optional)

Mailing Address

Address Line 1
Address Line 2 (optional)
Postal Code
Alternate Delivery Address (if different from above)

Delivery Address

Address Line 1
Address Line 2 (optional)
Postal Code
Special Delivery Instructions (optional)

Terms and Conditions Agreement

I understand that HealthConnect Pharmacy collects the information on this form for use in contacting me, providing MyRx Services, processing orders and for my medical and insurance coverage.

By selecting I AGREE and sending this form, I am giving consent for HealthConnect Pharmacy to contact me to verify and complete my registration, as well as using this information for the purposes stated above and in the Privacy Policy

I have read and agree to all the terms and conditions of the Privacy Policy.
Please send me refill reminders by email.
Please sign me up for health and wellness tips and info.