Request a Prescription Refill

If you’re an established patient at Alexander Medical and need a prescription refill, you can request it quickly using the form below.

Please note that this form is for non-urgent refill requests only. Refills are processed during regular business hours, and some medications may require a provider review or follow-up appointment before approval.

If you’re experiencing side effects, dosage issues, or need a new medication, please schedule a visit instead of using this form.

Name(Required)

First Last

Phone(Required)

Email(Required)

Date of Birth(Required)

Medication Requested(Required)

Pharmacy Name(Required)

Important Notice:This form is for established patients of Alexander Medical requesting a prescription refill for existing medications only. Do not include any sensitive medical details or questions about new conditions. Refill requests are reviewed during regular business hours. Please allow up to 2 business days for processing. If you are out of medication, experiencing symptoms, or need immediate assistance, call our office directly or contact your pharmacy for temporary supply options. For medical emergencies, call 911 or go to the nearest emergency department.