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Prescription Renewals

If you are being treated for a chronic condition, you may need to be seen by a doctor before the prescription is refilled.

Please allow one full business day for prescription to be refilled.

* indicates requird fields.

    *Your Name

    *Your Email Address

    *Your Phone Number

    Date of Birth

    Prescribing doctor

    Drug name & dose
    (if known)

    Number of pills requested

    Additional refills requested
    (if any)

    Pharmacy phone number

    Comments

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