Prescription Refill Request

Patient Information
Prescription #1
(In mgs/mls)
Prescription #2
(In mgs/mls)
Pharmacy Information
Comments
Important: We can only refill a prescription if the patient has a follow up appointment scheduled with us to manage the condition for which the medication is prescribed. If you do not have a follow up appointment scheduled, please call us at 717-569-8518. We will refill the prescription after the follow up appointment is made.
Enter security code:
 Security code

Call: 717-569-8518
Fax: 717-569-3903

Lancaster Office
1725A Oregon Pike
Lancaster, PA 17601

Directions
Brownstown Office
4221 Oregon Pike
Ephrata, PA 17522

Directions
Mount Joy
779 East Main Street
Mount Joy, PA 17552

Directions