- By completing this form you will request
that the pharmacy prepare a prescription refill for pickup in
the morning or afternoon, the next day. Refills are subject to
availability of your medication. We will contact you if your prescription
cannot be filled.
- This form is for requesting refills of
prescriptions already filled at our store. State law requires
that all new prescriptions be delivered in person or be phoned
in by your doctor. We gladly welcome transfers of prescriptions
from other pharmacies. Please call to have your prescription transferred
at no cost to you.
- This refill request is subject to availability
of refills on the requested prescriptions. If no refills remain,
you must first contact your doctor to obtain a new prescription.
Check your bottle label to
determine if refills remain.
- If anything about your medical condition
or insurance has changed, please add a comment. Your health is
important to us -- by giving us this information before we fill
your prescription you can avoid delays and unnecessary side effects.
- All personal information submitted on
this form will be held in strict confidence and is covered by
it carefully before submitting.
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All Rights Reserved.