Please chooose from the tabs below to refill your prescriptions.

Standard Medication Prescription Refill Request Form

  • Please allow 7 days for prescription refills.

    If you live in Vermont, please contact your pharmacy for your refill request. If your prescription is a compounded medication, please contact your pharmacy for your refill request. All others, please complete this form.
  • Medication One

  • Please provide name shown on current label
  • Medication Two

  • Please provide name shown on current label
  • Medication Three

  • Please provide name shown on current label

Controlled Substances Prescription Refill Request Form

  • Please allow 7 days for prescription refills.

  • Medication One

  • Please provide name shown on current label
  • Medication Two

  • Please provide name shown on current label
  • Medication Three

  • Please provide name shown on current label