Rx Refill Request

Allow three full business days. Please note that some mail-in pharmacies take up to 3 weeks to refill prescriptions. All controlled substances must be picked up in person.

Fill in all appropriate fields. (*=required field). To send, press the “SUBMIT” button at the bottom of the page.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • 1. FAX is our preferred and most efficient method of communicating requests to pharmacies. (Not for controlled substances.)
  • 2. MAIL: Enter YOUR address (not a pharmacy) below to have your RX mailed to you.