Language
  • English (US)
  • Chinese
  • Español
  • Korean
  • Russian
  • New Patient Registration

    Welcome to ahma Rx! Please provide the below information so we can get you your prescription as quickly as possible. Thanks!
  • **This form is not for Covid vaccine appointments**

    Please use this form if you are interested in pre-registering for a Covid vaccine appointment. 

     

  • We have partnered with Healnow and Nimble to offer secure checkout links once your prescription is ready to be scheduled for delivery. Please keep an eye out for a separate text message with a secure link to set up delivery.

     

    You can also text or call us directly if you do not want to set up delivery through the secure link. 

  • Which doctor(s) are we expecting a prescription from? (Optional)

     

  •  -  -
    Pick a Date
  • Please Take a Photo of the Front and Back of your Prescription Insurance Card (We will need the RX BIN, PCN, GRP, and ID.)

  • If you are unable to provide a photo of your insurance card, please provide the following:

  • We offer the following items to be added on to your prescription delivery. When confirming your prescription order, please let us know if you would like to add any of these items.

    • KN95 Masks (5 count) $15
    • Cetaphil Gentle Skin Cleanser (4 oz) $3.99
    • Cetaphil Intensive Moisturizing Cream (3 oz) $3.99
    • Cetaphil Daily Facial Cleanser (4 oz) $3.99
    • Cetaphil Moisturizing Lotion (4 oz) $3.99
  • Clear
  •  -  -
    Pick a Date
  • Thanks for submitting your info! We will reach out to you shortly. Please expect a text message or call from us. If you have any questions, you can call/text us as 212-749-6626. 

  • Should be Empty: