877-999-1928   |   GRP: HISI

Fax: 862-242-5649

Prescription Upload

A valid prescription from your doctor is required to place an order.

Upload your information, one item at a time, by:

1. Clicking the "Browse..." or "Choose File" button,

2. Selecting the image from your device,

3. Entering the Security Code displayed and clicking "Submit".

Repeat the previous 3 steps for each additional upload.


Your Name: *  

Your Email: *  

Your Phone:       (999-999-9999)

Your Prescription: (Please select only jpg, jpeg, jpe, png, bmp, or pdf files.) *  

Enter Security Code: *  



If you prefer, send your prescription via FAX: 862-242-5649 or email: ScriptUpload@HISIGlobalRx.com


Note: We do not share or sell your information to third parties.