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* Rx Number Note:  To protect your privacy, please do not type names of medications or other health information aside from your prescription refill number into this form. To refill your prescription online, we need to have the original paper copy and your insurance information on file. Please stop by with your new prescriptions, or ask your doctor to call us, so we can set up your account. It just takes a moment. You may also mail us your prescription and insurance information. If you'd like to receive email reminders in plenty of time to order your refills, just check the box. If the refill is for another member of your family, please enter that name below. We will never disclose youe email address, so don't worry about spam. Thanks!