CALL FOR AN APPOINTMENT TODAY.

419-334-3869

Prescription Refill Request

As a patient of Community Health Services, you have the ability to request prescription refills online. Simply complete the information below and a refill will be sent to your pharmacy within 24-48 hours
(not including weekends).

Patient Info

First Name:
Last Name:
Date Of Birth:
Telephone:
Email Address:

Request Info

Provider:
Name of Medication:
Dosage:
Frequency:
Pharmacy Name:
Pharmacy Address:
Pharmacy Phone:
 

Stay Connected