Medicine Refill

Please note that this request is a non-emergency and can be answered within he next 24-48 hours during the business week. For immediate assistance please call 913-269-7011. Thank You.

What medicine do you need refilled? Include medicine name, dose and quantity desired.

Your Name (required)

Phone number where you can be reached

Your Email (required)

Date of Birth
    ,

Your Pharmacy's Phone Number:

 By submitting this form, I agree that this request is non-emergency and can be answered within the next 24 to 48 hours during the business week. I agree that no refills will be done for pain meds or conditions that have not been evaluated recently by one of our physicians.

Please type the code below to verify your submission
captcha  

×
15100 Metcalf Ave, Suite 101 | Located inside the Central Bank of the Midwest | Overland Park KS 66223 | Phone: 913-685-0212 | Fax: 913-685-0092 | Powered by: mindspike