Asensa Drop Refills

For your safety, masks are REQUIRED at the time of pickup.

Delivery Method This field is required.

Pickup Location This field is required.

Street Address This field is required.

Address Line 2 This field is required.

City This field is required.

State / Province / Region This field is required.

ZIP / Postal Code This field is required.

First Name This field is required.

Last Name This field is required.

Are you placing this order for someone else? This field is required.

First Name of Patient This field is required.

Last Name of Patient This field is required.

Date of Birth This field is required.

Email This field is required.

Phone This field is required.

This field is required.

Check the box if you have your credit card on file with us and would like to use that payment method for your order.

In order to use this service we require a completed and signed credit card authorization form. If you would like to sign up, please call 832-678-8368 to obtain the form and instructions

This field is required.

Submit

Please note that we will use this email to send notification when your order has shipped or is available for pick up in the office.

We will send an email link for payment if necessary.

Orders are available within 5 business days, after the payment has been received.

The shipping fee for your order is $10.

Due to Texas Medical Board Regulations, antigen may not be shipped outside of Texas.

*In order to use this service we require a completed and signed credit card authorization form. If you would like to sign up, please call 832-678-8368 to obtain the form and instructions.

With 15 convenient locations across the greater Houston area, we’re never far away.