Prescription refill
Existing medication review, pharmacy routing, and refill request.
- Medication and dose
- Prescriber or label details
- Preferred pharmacy
Online care request
Online prescription refills and televisits
Choose a refill or televisit, add the details your care team needs, and submit a secure request for clinician review.
- 1. Choose care
Refill or televisit - 2. Answer questions
Only details needed for review - 3. Clinician review
Care plan or next step after intake
Start with what you need
Select prescription refill or televisit before adding patient and payment details.
Televisit
Short virtual visit for straightforward care needs.
- Pick a common concern
- Choose a preferred time
- Clinician reviews next steps
Guided intake questions
Patients can search medication names, pharmacies, prescribers, and insurance carriers, optionally use browser location to suggest nearby saved pharmacies, then use quick options for refill timing, common televisit concerns, preferred visit windows, contact preference, and policy holder details.
A form-only smart intake guide and local form assistant help patients copy details from medication labels, insurance cards, optional photo ID barcode autofill, voice or typed answers, and tap-to-build note templates without sending information to an outside AI service. The intake supports English, Spanish, and French.
Make sure this request fits online care
Use this form for non-emergency prescription refill requests and simple virtual care needs. If symptoms feel urgent or severe, seek emergency care instead.
Common questions
Prescription refill and televisit FAQ
Can I request a prescription refill online?
Yes. Use this intake for existing medication refill requests that can be reviewed by a clinician. A prescription decision is made only after clinical review.
What is a televisit?
A televisit is a short virtual care request for straightforward concerns, medication questions, or follow-up needs that do not require emergency care.
Can I use insurance or self-pay?
Yes. Choose insurance to add plan details for eligibility review, or choose self-pay to see the listed cash rate before submitting.
When should I not use this form?
Do not use this form for emergencies, severe symptoms, chest pain, trouble breathing, or anything that needs immediate attention.