Convenient and Quick Refill Requests Please complete and submit the form below. Refills typically take 1-2 days to process. Name * First Name Last Name Email * Date of Birth * Medication Name * Controlled Substance? * Yes No 30 or 90 Days? * 30 days 90 days Pharmacy Name * Pharmacy Address Additional Refill Info Thank you! Refills typically process in 1-2 days.
