Patient Credit Card Form

VLS Pharmacy requires written permission to charge your credit card for all items (prescriptions, vitamins, medical supplies, and retail).

Please print this form, complete all areas and fax to: 855-491-0799 OR email to info@vlspharmacy.com.

Credit Card Form – Download PDF (click to download)

Thank you for your cooperation!

COVID-19 Vaccinations are now available at VLS Pharmacy in Brooklyn, NY.
If appointments are unavailable, please check back frequently as New York State is systematically allocating vaccines. As we receive more vaccines, more spots will open.
Please note: we CANNOT book your appointment over the phone due to the screening requirements.

Please text us with your prescription refill requests: VLS Pharmacy: 844-857-5588 | New Drug Loft: 212-879-0910.
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