Please read and become familiar with our Prescription Refill Policy
After filling out form completely; attach form to an email and send it to: prescription@mypchc.net
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All prescription refill requests require the following information for your safety:
1.
Full name, as appears on your insurance
card.
2.
Your birth date.
3.
A telephone number where you can be
reached.
4.
The complete name of the medication.
5.
The dosage of the medication.
6.
The frequency with which the medication is
taken.
7.
The name and telephone number of your
pharmacy.
8.
Any medication allergies.
9. A list of all other medications both prescribed and non-prescribed that you are taking