RX Refill: Pick Up at Prescription Lab

 

Use this form to request a prescription refill you will pick up at Prescription LabAll fields marked with an asterisk (*) are required.

We will call you at the phone number you enter below when your prescription is ready for pick-up.

Name *
Name
Phone *
Phone
We will call you at this number when your prescription refill is ready for pick-up.
Date of Birth *
Date of Birth
Enter up to five prescription refills and then scroll to the bottom to send
PRESCRIPTION REFILL 1
PRESCRIPTION REFILL 2
PRESCRIPTION REFILL 3
PRESCRIPTION REFILL 4
PRESCRIPTION REFILL 5