please enter name of patient requesting a medication renewal
(Use YYYY-MM-DD for date and HH:MM:SS for time)
please list name of the medication you are taking
please enter the strength of medication you are taking
please enter how many times you take your medication
please inform us how you would like your Rx generated
Name, strength and how many times a day you take this medication. Multiplt meds can be listed here.
please enter name of pharmacy and location