TOUCH FREE Order Form | Pharm House Drug Co.

TOUCH FREE Delivery/Curbside Pick up Order Form

Let us be your personal shopper!

A message about COVID-19: We at Pharm House Drug care about the health of our patients, staff, and community. Therefore, we are putting in place new prescription TOUCH FREE Delivery and Curbside Pick Up measures to protect our patients and staff.

Please, fill out our new TOUCH FREE Delivery/Curbside Pick Up form, and we will get in touch with you when your order is ready. Required fields have an * .

Curbside Pick Up is available at all Pharm House Drug locations Needville.
TOUCH FREE Delivery is available in Carrizo Springs, Crystal City, La Grange, Needville, Sonora, and Sweeny. Delivery is free of charge at this time.

Note: To receive TOUCH FREE Delivery you must have at least one prescription being filled.

Location Information
Choose your Pharm House Drug location:*
What service would you like to order? (Note: Based on availability of items. A $5 delivery fee is added to TOUCH FREE Delivery orders that do not include a prescription.)*
- Touch Free Delivery
- Curbside Pick Up
What date would you like your order delivered? Note: Touch Free Delivery not available on Saturday or Sunday*
Date Format: MM slash DD slash YYYY
What date would you like your order delivered? Note: Touch Free Delivery not available on Saturday or Sunday*
Date Format: MM slash DD slash YYYY
What date would you like to pick up your order curbside? Note: Curbside Pick Up is not available on Sunday*
Date Format: MM slash DD slash YYYY
What date would you like to pick up your order curbside? Note: Curbside Pick Up is not available on Sunday*
Date Format: MM slash DD slash YYYY
Car Description: make/model/color*
Car Description: make/model/color*
Contact Information
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Phone*
Email*
Prescriptions Needed
1.) Refill #
1.) Medicine Name
2.) Refill #
2.) Medicine Name
3.) Refill #
3.) Medicine Name
Need more prescriptions refilled?
- No
- Yes
Additional Refills
4.) Refill #
4.) Medicine Name
5.) Refill #
5.) Medicine Name
6.) Refill #
6.) Medicine Name
Other Items
Would you like to add any non-prescription items to your order? Options include, but are not limited to these departments:
- Nuts/honey/Biolyte
- Gift items
- Candy/drinks
- Cough/cold
- Allergy
- Pain relief
- Wound care/first aid
- Oral care
- Eye care
- Feminine hygiene
- Vitamin supplements
Please list requested items below: (Note: Based on availability of items.)
Please list requested items below: (Note: Based on availability of items.)

Pharmacy Phone Numbers:

Pharm House Drug Carrizo Springs: 830-876-2516
Pharm House Drug Crystal City: 830-374-3436
Pharm House Drug Kountze: 409-246-3492
Pharm House Drug La Grange: 979-968-5835
Pharm House Drug Needville: 979-793-5534
Pharm House Drug Sonora: 325-387-2541
Pharm House Drug Sweeny: 979-459-2220
Pharm House Drug Trinity: 936-594-3593

TOUCH FREE Delivery/Curbside Pick up Order Form

Location Information

Contact Information

Prescriptions Needed

Additional Refills

Other Items

Would you like to add any non-prescription items to your order? Options include, but are not limited to these departments:

Pharmacy Phone Numbers: