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Request A Prescription

This online Rx form is no longer functional.

For all prescription refills, please email your request to This email address is being protected from spambots. You need JavaScript enabled to view it.. Please include in the email, the patients name, medicine name and dosage, and the pharmacy.

The Tarnow Center is now using e-prescribe software for all new and refilled prescriptions including controlled substances. Along with your prescription details we will need to know your pharmacy name and phone number or address.   We require a 48-hour notice to refill a prescription. 

Along with the pharmacy information please leave the following information: Patient’s name, date of birth, name of the medication, strength of medication, quantity of the refill and how often you are taking the medication throughout the day.