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 RENTON  425.228.0722                COVINGTON  253.630.3644                BUSINESS OFFICE  425.271.4303

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Prescription Refill Requests


In most cases, your health care provider has written a prescription for you for one year.  

In all cases, we ask that you please call your pharmacy before making a refill request.  If your pharmacist has a question, he will call our office.  

This will save both you and our office time!

If you know you need your doctor's permission for a refill, please use this form.  Your request will be e-mailed to our office.

Your prescription refill request (e-mail message) is sent to our clinic via the internet. Although we feel confident your messages to our clinic are secure,  the internet offers no absolute guarantee of confidentiality in regard to e-mail.  Please consider this fact when sending sensitive information.

If you like, you may call our office at 425-228-0722

 

Pharmacy Information:

Pharmacy Name: 


Location of Pharmacy:



Daytime Phone Number:

 

Prescription Information
(Please include dosage)
  

 

Patient Information

Name:

Date of Birth:

Address:

Daytime Telephone:

E-Mail:

Physician:

  

 

 

 


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VALLEY WOMEN'S CLINIC, PLLC
17722 Talbot Road South
Renton, WA 98055
425.228.0722

©  2003 - 2008

 

Disclaimer: The content of Valley Women's Clinic website is for information and health education only. We do not intend to offer medical advice, legal advice, or treatment of any kind. It is important to note that information on this site is not a replacement for diagnosis or treatment by a licensed health care professional.