Prescription Refills

Use the Prescription Form below to request a refill online.

Prescriptions and refills are issued during regular office hours. Have your pharmacist call us during these hours for refills. If you need a written prescription let us know in advance and we will mail it to you. By law, narcotic prescriptions must be in written form and cannot be called in to your pharmacy.

Office Hours

Routine calls are handled during regular office hours:
Monday through Friday 8:30 a.m. to 5:00 p.m.

Haverhill, Newburyport, & RiverWalk Offices: 1-888-227-3762
Georgetown Office: (978) 352-8375
Methuen Office: (978) 738-8050

Please have your pharmacy’s telephone number ready in case you require medication.

ONLINE PRESCRIPTION REFILL FORM - Please fill out all pertinent fields.

Name

Birth Date (Month) (Day) (Year)

Prescription #1 Name
Prescription Dose
Prescription Directions

Prescription #2 Name
Prescription Dose
Prescription Directions

Prescription #3 Name
Prescription Dose
Prescription Directions

Prescription #4 Name
Prescription Dose
Prescription Directions

Pharmacy Name

Pharmacy Phone

Pharmacy Address

City

State Zip
Is this a mailorder pharmacy? Yes No

Prescribing Physician

Comments



Your Email

Primary Phone


Secondary Phone

NOTE: You may want to print this page for your records before submitting the form.