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Pharmacy Prescription Refill Request

Your Contact Information:

Name:*
E-mail address:*

Pharmacy Location:



Refill Information:

  Rx # (preferred) or drug name Patient name (last, first)
1)
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Additional information you would like to tell our pharmacists...
I have read and understand the University of Kentucky's Notice of Privacy Practices.
Please allow at least 4 hours before picking up a refill that has been requested online.
Submission of your name and e-mail address is necessary so we can contact you if we need to about your refills. Your e-mail address will be kept private and will not be added to any mailing lists.