Please Read The Following
The Prescription Refill Request form is for the convenience of our current patients. This helps minimize phone calls and allows our office staff to meet your needs while taking care of other patients in the office.
Terms and conditions:
Submitting this form does not guarantee prescription authorization. Please only submit this form if you are a current patient of Beacon of Hope. Repeated medication refill requests will not be authorized.
Fill in the form clearly with the exact name of the medication, dose, and accurate pharmacy information.
Do not call the office to check the status of your request. Please check with your pharmacy if you have any refills left on your last prescription before sending in this request, and/or to check the status of your refill after submitting.
Use this form for medication refill requests only. Do not use this for any other purposes. For all other requests, or if you need to speak with a member of our team, please call us at (513) 516-9293.
It can take 1-3 days to respond to your request, or longer if requested on Fridays or during holidays. Check with your pharmacy about the status of your prescription in 24–72 hours. You do not need to call the office. We will notify you if medications are not called in for any reason.
12756*_*Perscription Refill Request
