Medication Refill Request Form
BEFORE COMPLETING THIS FORM, PLEASE CALL YOUR PHARMACY TO SEE IF THERE IS A REFILL ON FILE AVAILABLE TO YOU. IN ABOUT 85% OF CASES, PATIENTS HAVE A REFILL WAITING AT THE PHARMACY THAT COULD BE FILLED, IF REQUESTED. CALLING THERE FIRST WILL SAVE YOU TIME. THANKS!
Have you called your pharmacy to see if a refill is available to be filled?
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