Botsford Health Care Continuum - Pharmacy Prescription Refill

Sections:

home / services / pharmacy

Thank you for using our online prescription refill service. Please provide the following information in order to process your request.


Patient Information:
First Name:
Last Name:
Phone Number:
E-mail Address:

Refill Information: Provide the Rx number(s) for the prescription(s) you need refilled (up to 10).
Prescription 1:
Prescription 2:
Prescription 3:
Prescription 4:
Prescription 5:
Prescription 6:
Prescription 7:
Prescription 8:
Prescription 9:
Prescription 10:

Pick-Up Information: Provide a desired date to pick up your refill. Allow three hours for processing. If you wish to ensure against a partial refill, please allow three days. <-- Click here to select date

Comments: Enter the text as it is shown in the above box: