6570 170 Ave NW

Refill Prescription

Full Name

Birth Date

Contact Information

Prescription Information

Additional Notes

Please enter any special instructions or notes concerning your prescription or list additional required prescriptions.

If you select to have it delivered, we will call to confirm your address.

I agree that my request for a prescription refill will be transmitted to the pharmacy shown near the top of this page. Once the pharmacy has received my request, it will be handled in the same manner as all refill requests, subject to the dispensing pharmacist's professional judgement. By entering the prescription information, I have consented to a pharmacist having access to my personal health information. I also authorize the pharmacy to contact my physician by phone or fax, if my prescription does not have refills. If my prescriber does not allow these types of refills, an appointment may be necessary. Please note that as with all technologies, there may be interruptions or technical failures. Apollo Pharmacy expressly denies any liability for technical failures, incomplete, scrambled or delayed transmissions and/or technical inaccuracies.