Urgent Refill Request
Hi! We're Twentyeight Health, and we are excited to have you join our community. As we continue to receive updates from SimpleHealth, we want to be sure you can receive the care you need!

If you need your refill urgently, please provide your information here. If SimpleHealth is still in the process of sending your delivery, we will use this to secure an update for you. If not, we will use it instead of your scheduled refill timing, to make sure you can receive your prescription ASAP (if supported by your insurance)! 

Please note this form is currently the best way to accelerate your order. Thank you for understanding! 
Email *
First Name *
Last Name *
Date of Birth *
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Email address associated with your Simple Health Account *
Date you need your prescription *
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