NON Urgent Prescription Refill Request

NON Urgent Prescription Refill Request

As of July 15, 2013, the form on this page will no longer be available for use. All prescription refill requests will be processed through our NextMD Patient Portal. Please enroll in our patient portal by clicking on the enrollment link below. If you are already enrolled in our NextMD patient portal, please sign-in to your account and request prescription refills through the patient portal. You will experience the same convenient and secure assistance as you have in the past. To find out more about our patient portal and how to connect directly with your doctor's office, please visit our NextMD patient portal web page.

Effective January 1, 2011, laws are changing for over-the-counter medications being reimbursed from your flexible spending account (FSA), health savings account (HSA), or health reimbursement account (HRA). Over-the-counter medications (such as aspirin, cold remedies, antacids, etc.) may require a prescription from your physician in order to qualify for reimbursement. To facilitate your requests, patients with an established Watson Clinic physician may fill out the prescription refill request form (below) for these over-the-counter medications. These type of prescriptions will be required for pick-up at the physicians office.

The following information will be used by our physicians and nursing staff to assist you in refilling your prescription(s). This information will not be forwarded to any non-related area or entity. When you submit personal information, we use a secure server for information storage which protects patient information against unauthorized access.

Online Prescription Refill Requests:

  • Are to be used for NON URGENT refills only. If you need immediate or more time sensitive assistance, please contact your physician’s office directly.
  • Online Prescription Refill Requests may NOT be used for requesting a new medication or a narcotic prescription request.
  • Multiple prescription refills may be submitted, but for each refill you must specify the ordering physician.
  • Your online request will be followed by an email confirmation of your request. For patient privacy reasons, the staff from Watson Clinic will not communicate with you via email.
  • We will contact you only if there is a problem processing your request. That contact will be made by phone.
  • We recommend that you confirm with your pharmacy prior to picking up your prescription. Watson Clinic has an in-house pharmacy located at the Main Clinic and available for patients as needed.
  • If you are requesting a paper copy of a prescription, please allow five business days for delivery.

If you need immediate assistance, please call your physician’s office directly. Click here for the Call Center phone directory.

We will respond to your request within two business days, except when the clinic is closed for weekends and holidays.

* Required Information

Date:
* Person Submitting the Request:
* Relationship to Patient:
* Patient Last Name:
* Patient First Name:
Patient Middle Initial:
* Date of Birth:
mm/dd/yyyy
Watson Clinic Number:
* Primary Telephone Number:
000-000-0000
* Patient Email Address:
* Select Prescribing Physician:
select
* Drug Name:
(Please refer to prescription bottle for correct spelling & dosage)
Dosage:
* Is a 90 day supply needed for a mail order request?
* How do you want to receive your prescription?
(If you choose this option please allow five business days for processing)
Comments:
Enter the code shown:

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