Routine medication
Other Medication Refill
Use this form for medications that are not controlled substances. Your doctor will send the prescription electronically to your pharmacy.
Call your pharmacy first. Use the portal only if you do not have any refills left.
Include in your portal message:
Copy and paste this list into your portal message and fill in your details.
- Your pediatrician (which provider you see)
- Parent name
- Preferred phone number
- Pharmacy name
- Pharmacy address
- Confirmation that you've called the pharmacy and there are no refills left
- Medication name
- Dose
- Quantity
- Generic or brand name preference
