​NEED A PRESCRIPTION RENEWAL​

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***IMPORTANT***

PLEASE READ AND SUBMIT WITH YOUR REQUEST. ALL OTHER REQUESTS WILL NOT BE REVIEWED IF MISSING INFORMATION

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• ​If you have not seen your family physician for some time you may be required to still come in for an appointment

• Fax prescription renewals are an uninsured service and there will be a fee per medication renewed.  

• When submitting a request online it will be implied that you are agreeing to pay the fee, if your physician renews it. 

• You will receive an email from Patient Serv with the invoice and payment is due upon receipt. 

• Please list the name of the prescriptions you are requesting for renewal, along with the dose and frequency in which you take the medication.

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I agree to the terms above and would like my prescription renewed