{"id":1772,"date":"2025-04-29T05:54:47","date_gmt":"2025-04-29T05:54:47","guid":{"rendered":"https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/?page_id=1772"},"modified":"2026-10-08T08:58:29","modified_gmt":"2026-10-08T08:58:29","slug":"delivery-rx","status":"publish","type":"page","link":"https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/delivery-rx\/","title":{"rendered":"Delivery Rx"},"content":{"rendered":"\n<div class=\"et_pb_section_0 et_pb_section et_section_regular et_block_section\"><div class=\"et_pb_row_0 et_pb_row et_pb_equal_columns et_block_row\"><div class=\"et_pb_column_0 et_pb_column et_pb_column_1_2 et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_text_0 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-text--cd48c4ae-ff4b-4126-ad3f-ff80d3e5223b\"><div class=\"et_pb_text_inner\"><h1>Delivery Rx<\/h1>\n<\/div><\/div><div class=\"et_pb_text_1 et_pb_text et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-text--c8496805-3cdf-4c6e-829a-f469d6038e7c\"><div class=\"et_pb_text_inner\"><h5>Complete our secure form below to become a new patient. Need help? Call us for immediate assistance <a href=\"tel:732-721-1732\">732-721-1732.<\/a><br \/>\n<\/h5>\n<\/div><\/div><div class=\"et_pb_module et_pb_button_module_wrapper et_pb_button_0_wrapper preset--module--divi-button--1bffc0fc-42a0-49d1-bd9a-ae3ade2d7206_wrapper\"><a class=\"et_pb_button_0 et_pb_button et_pb_bg_layout_light et_pb_module et_block_module preset--module--divi-button--1bffc0fc-42a0-49d1-bd9a-ae3ade2d7206\" href=\"#transfer-here\">Fill Out Delivery Form<\/a><\/div><\/div><div class=\"et_pb_column_1 et_pb_column et_pb_column_1_2 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_image_0 et_pb_image et_pb_module et_block_module\"><span class=\"et_pb_image_wrap\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/wp-content\/uploads\/sites\/63\/2024\/09\/transfer-prescription.webp\" width=\"900\" height=\"600\" srcset=\"https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/wp-content\/uploads\/sites\/63\/2024\/09\/transfer-prescription.webp 900w, https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/wp-content\/uploads\/sites\/63\/2024\/09\/transfer-prescription-480x320.webp 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 900px, 100vw\" class=\"wp-image-1289\" alt=\"transfer-prescription\" title=\"transfer-prescription\" \/><\/span><\/div><\/div><\/div><\/div><div class=\"et_pb_section_1 et_pb_section et_section_regular et_block_section\"><div class=\"et_pb_row_1 et_pb_row et_block_row\"><div class=\"et_pb_column_2 et_pb_column et_pb_column_4_4 et-last-child et_block_column et_pb_css_mix_blend_mode_passthrough\"><div class=\"et_pb_code_0 et_pb_code et_pb_module\"><div class=\"et_pb_code_inner\">    <div class=\"delivery-form-container\">\n        <h2 style=\"text-align: center;\">Request Free Prescription Delivery<\/h2>\n        <p class=\"required-note\">Fields marked with * are required.<\/p>\n\n        <form id=\"delivery-form\">\n            <div class=\"form-row\">\n                <div class=\"form-group\">\n                    <label for=\"delivery_first_name\">First Name*<\/label>\n                    <input type=\"text\" id=\"delivery_first_name\" name=\"first_name\" placeholder=\"Enter first name\" required>\n                <\/div>\n                <div class=\"form-group\">\n                    <label for=\"delivery_last_name\">Last Name*<\/label>\n                    <input type=\"text\" id=\"delivery_last_name\" name=\"last_name\" placeholder=\"Enter last name\" required>\n                <\/div>\n            <\/div>\n\n            <div class=\"form-row\">\n                <div class=\"form-group\">\n                    <label for=\"delivery_phone_number\">Phone Number*<\/label>\n                    <input type=\"tel\" id=\"delivery_phone_number\" name=\"phone_number\" placeholder=\"Enter phone number\" minlength=\"8\" maxlength=\"12\" pattern=\"\\d{8,12}\" title=\"Please enter 8 to 12 digits\" required>\n                <\/div>\n                <div class=\"form-group\">\n                    <label for=\"delivery_email\">Email Address*<\/label>\n                    <input type=\"email\" id=\"delivery_email\" name=\"email\" placeholder=\"Enter email address\" required>\n                <\/div>\n            <\/div>\n\n            <div class=\"form-group\">\n                <label class=\"checkbox-container\">\n                    <input type=\"checkbox\" id=\"subscribe_free_delivery\" name=\"subscribe_free_delivery\" value=\"yes\">\n                    <span class=\"checkbox-label\">Yes, I want to subscribe for Free Prescription Delivery<\/span>\n                <\/label>\n            <\/div>\n\n            <div class=\"form-group\">\n                <label for=\"notify_when_ready\">Would you like us to notify you when your prescription(s) are ready?<\/label>\n                <select id=\"notify_when_ready\" name=\"notify_when_ready\">\n                    <option value=\"no\">No, thanks<\/option>\n                    <option value=\"yes-sms\">Yes, Send me SMS<\/option>\n                    <option value=\"yes-call\">Yes, Call me<\/option>\n                <\/select>\n            <\/div>\n\n                        \n                            <div class=\"form-group\">\n                    <div class=\"cf-turnstile\" data-sitekey=\"0x4AAAAAADXRCWv3X8Yo3WY1\"><\/div>\n                <\/div>\n            \n            <div class=\"form-submit\">\n                <button type=\"submit\" class=\"submit-btn\">Submit<\/button>\n            <\/div>\n            <div id=\"delivery-message\"><\/div>\n        <\/form>\n    <\/div>\n<\/div><\/div><\/div><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-1772","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Delivery Rx - JDX Pharmacy Website<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Delivery Rx - JDX Pharmacy Website\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pharmacysites.wappnet.us\/jdxpharmacy\/delivery-rx\/\" \/>\n<meta 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