My Medical Care

PRESCRIPTION REFILL REQUEST

Please fill out the form below to request a prescription refill. After completing the form, a Medical Care employee will contact you to confirm your request.

Please Note! Internet prescription requests are handled as priority & similar to telephone requests. Please allow 72 hrs to process medication requests.

NEW! You can now have your medical prescriptions refilled at Medical Care. Our pharmacy in the Johnson City and Elizabethton offices is now open and the pharmacy in the Elizabethton office will be opening soon!

Name*
Phone*
Alt Phone
Email
Account Number
DOB*
Month/Year
/

Pharmacy Name*
Pharmacy Location*
Pharmacy Phone
Pharmacy Fax

Prescriptions*
Name & Dosage

*required