We are happy to refill your prescriptions on line.
Please fill out the form below and submit it to our office by e-mail at firstname.lastname@example.org or fax it to (203) 438-4266. We are checking our e-mails and faxes at 8:00 a.m. & 1:00 p.m. Mon- Fri .
Prescription requests received by 8:00 a.m. will be ready for pick-up or in the mail by 1:00 p.m. the same day (Mon-Fri). Prescription requests received by 1:00 p.m. will be ready for Pick-Up by 5:00 p.m. the same day or in the mail the following morning (Mon-Fri).
Please check the box stating whether the prescription is to be mailed or picked up at the hospital.
Please make arrangements for payment of medication to be mailed, in advance, or at time of order. We can take credit card numbers over the phone.
If the prescription mailing address is different from your home address please give that address.
Postage & Prescription Fees:
- All prescription refills will be mailed US MAIL Priority Second Day.
- Mailing fees will be based on package weight and destination. We work hard to obtain the most efficient shipping with the best rates!
- There will be no postage charge for standard US Mail ground delivery to your home for any prescription over $45.00 filled at our hospital.
- All prescription refills to be mailed must be paid by credit card at time of order.