Finger Lakes Family Care Rx Request

please enter name of patient requesting a medication renewal

(Use YYYY-MM-DD for date and HH:MM:SS for time)

Date
Time
Date
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