Hello world! – Select POC Prescription Discount Card

Email Card
Fill out the information below and a prescription card will be generated and sent to the email provided.
Name*
First Last
Email*

Your email will not be shared.
Phone*
Your phone number will be your card ID number.
Universal Rx will keep your information safe and private. We will NEVER provide your numbers to a third party organization. Nor will we EVER use this number to send you spam or junk messages.
Email
This field is for validation purposes and should be left unchanged.

Print Card
Fill out the information below and a prescription card link will be generated for you to print.
Name*
First Last
Phone*
Your phone number will be your card ID number.
Universal Rx will keep your information safe and private. We will NEVER provide your numbers to a third party organization. Nor will we EVER use this number to send you spam or junk messages.
Comments
This field is for validation purposes and should be left unchanged.

Share Card
Share this card through email with your friends and family and they will be able to receive prescription discounts. If you need to share to more than 4 people, you'll need to fill out the form again.
Your Name*
First Last
Your Email*
Friend's Email 1*
Friend's Email 2
Friend's Email 3
Friend's Email 4
Email
This field is for validation purposes and should be left unchanged.

Text Card
Fill out the information below and a prescription card will be generated and sent to your mobile phone. You must be able to receive image texts. Standard message rates apply.
Name*
First Last
Phone*
Your phone number will be your card ID number.
Universal Rx will keep your information safe and private. We will NEVER provide your numbers to a third party organization. Nor will we EVER use this number to send you spam or junk messages.
Phone
This field is for validation purposes and should be left unchanged.