Prescription Refill Form For Active Patients Only

Please complete form fields below and press submit. If there is a problem with your prescription refill request or we require more information from you, we will contact you by phone.

All requests will be processed within 48 hours during regular business hours, Monday – Friday, 8:30 am-5:00 pm. Once processed, your prescription will be available for pickup at your pharmacy within 48 hours. If you require an immediate refill or have a question, please contact our office at 845-452-1700.

Please be sure to include all of this information. Failure to do so will make it impossible to fulfill your refill request.