Medication Refill Request

To request a medication refill, complete the information below. If you do not provide ALL of the information requested below, we will not be able to process your refill request.

Please note:

  • FCS will ONLY refill current prescriptions that were prescribed by FCS staff
  • If you have missed a scheduled appointment with our medication provider, we will likely NOT refill prescriptions until you have been seen again
  • Please allow up to 48 hours for refill requests to be processed
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.