Pharmacy Refill Portal

Request medication refills to be sent to your pharmacy. You can add multiple medications in a single request. Our team will process your request within 24-48 hours.

Patient Information

Patient Full Name*

Date of Birth*

Phone*

Pharmacy Information

Pharmacy Name*

Pharmacy Phone*

Pharmacy Address

Medications

Medication #1

Medication Name *

Dosage *

Quantity *

Additional Notes

Please allow 24-48 hours for your refill request to be processed and sent to your pharmacy. If you are out of medication and need an urgent refill, please call our office directly. Some medications may require a current office visit before a refill can be authorized.

Text-message preference *

Choose whether iHealth Clinics may send texts to the mobile number entered in this form. Consent is not a condition of treatment or purchase.

Yes, I agree to receive appointment, scheduling, referral, records-request, prescription-refill, billing, and care-coordination texts from iHealth Clinics. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help.No, please contact me by phone or email instead.

View our Privacy Policy and SMS Terms & Conditions.