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Prescription Renewal Request

This form is to request non-urgent renewal of medications. Please allow 1-2 business days for your prescription to be sent. Please call the clinic or pharmacy if you have not received your prescription after 3 days.

Please check your bottle for refills before completing this form. Also, this form is not to be used for opioids, benzodiazepines or other controlled substances.  Those refills would require an appointment.


Thank you for submitting!

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