Prescription Refill Requests

To call in your prescription refill request dial 203-432-0033, press 1, then press 1 again and follow the prompts.

To submit your refill request online complete the form below and click the submit button. Please check your email for the confirmation email, it will let you know if all your prescription refills were successfully processed.


First Name:

Last Name:

Phone Number: ( ) -

E-mail Address:

Confirm E-Mail Address

Enter the prescription numbers for prescriptions that are ready to be refilled. the Prescription number is located on prescription label (click here to see a sample label).

Prescription #1:
Prescription #2:
Prescription #3:
Prescription #4:





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