Prescription refills

Request a refill.

For non-urgent refills only. Please allow 24–48 hours. For emergencies, call 911 or go to the ER.

Patient name *Date of birth *

Phone *Email

Pharmacy name *Pharmacy phone *

Medication name *Dosage *

Prescription numberRefills needed

Additional notes

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.

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Please don't include detailed medical records here. This form is transmitted securely; our team will collect clinical details directly.