Medication Request | Emple Health

Upload Prescription *

A prescription is required to process your request. Upload a clear photo or scan.

Tap to upload or drag & drop

PNG, JPG, GIF up to 5MB

Analyzing your prescription...

Extracting patient details and medications

Patient Details

First Name *

Last Name *

Age

Gender

Medications

Phone Number *

Enter your active mobile number so we can reach you.

How would you like to receive your medication?

Delivery

Get it delivered to your door

Pickup

Pick it up from a pharmacy

Location *

Type your neighborhood or use the GPS button for accuracy.

Emple Health Member Verification *

Member Number

Upload ID Card Photo

We'll extract your member number automatically

Name Mismatch Detected

The patient name on the prescription does not match the name on the member ID card. Please review carefully.

Prescription

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ID Card

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I acknowledge the name mismatch and accept full liability in the event of any legal issues related to impersonation.

EmpleHealth