Because all non-controlled prescriptions are required to be sent electronically, you must request refills through your local or mail order pharmacy. All other refill requests may be subject to a processing charge

Choose your medical provider Name * Date of Birth * Approx Date of Last Office Visit * Medication Name Strength or Dosage * How many times a day do you take medication Number of pills in last refill * Date of last refill Month of last office visit Other Information Preferred Method of Contact Preferred Contact Number or Email