Requesting a medication refill online is easiest when using this form. Please refer to the prescription label of the medication that you would like to have refilled. A few short notes:
1. This form may be used only for prescriptions purchased from our facility.
2. You will need to affirm that the patient is stable on the current treatment and that the medication dose has not been changed. If he/she is not, please call us to discuss refilling this medication.