Our Physician Practices  > Family Medicine Practices  > Twelve Mile Creek Family Medicine  > Request a Medication Refill 

Request a Medication Refill

 

 

Please include the following with your request for each medication you are requesting:

  • Your Name
  • Your Date of Birth
  • Name of your medication(s)
  • Dose of medication (usually a number with "mg" or "mcg" after it)
  • How many times a day you take and when (daily at bedtime, twice a day with breakfast and dinner)
  • Name of the provider who last filled the medication
  • Your pharmacy's name
  • Your pharmacy's address and phone number

Request Medication Refill  

 

Requests that are missing any of the above information will be returned to you and not filled until all information is received.

Please allow 24 hours to process your electronic request. You will receive notification via e-mail when your prescription has been  electronically submitted to your pharmacy.