If you are an established patient you may use this form to request a medication refill for a medication prescribed by one of our physicians.

 

You may also call 814-454-1085 (Refill and Rescheduling Line)

Please include the following information or your request will not be processed:
1) Your Full Name, Date of Birth, Address, and Phone Number
2) Medication Name, Strength, and How Many Times Per Day you take it
3) Pharmacy Name, Location, and Phone Number

* First name (required): * Last name (required): * E-mail address (required): Phone number: * Message (required):