Prescription Refill Form

Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Prescription Pickup Location*
What is your Prescription?*
What is the Dosage?*
Desired Pick-Up Date*
Date Format: MM slash DD slash YYYY

(YWC must be given 24hrs to verify prescription request and prepare for the patient)
Desired Pick-Up Time*
(YWC must be given 24hrs to verify, prepare and send prescription request)
Name of Pharmacy Prescription Should be Sent to*
Address of Pharmacy*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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Kaitlyn is amazing!

March 9, 2020

If you want to find someone who does injectables, Kaitlyn is the perfect match! It definitely helps that she is a NP and knows her way around needles. She never gives too much filler because she wants the results to look natural. I do Botox and Lip Filler and she always makes me feel very comfortable. I just had two rounds of BBL on my face and it is amazing how radiant my skin is. I had some sun damage (I don’t tan my face and use sunscreen, sunglasses and hats religiously) and a couple of sun spots that have almost disappeared. Had one treatment of BBL on my chest and it is incredible how much that treatment lightened up the sun damage after just one visit. BBL is literally pain-free. I would highly recommend Kaitlyn and Your Wellness Center. Everyone there truly wants what is best for you. A friendly and knowledgeable staff.

Beth McCoy