(561) 369-2144 info@drquinonez.com

Pharmacy

Patient Name

 

Medication

 

Dose (e.g. 10 mg, 20 mg)

 

Directions (e.g. once daily)

 

Quantity

 

Pharmacy name

 

Pharmacy telephone

 

Special Directions

 

Verification



Please fill out this form to request your prescription refill!

If you are having trouble, please feel free to call us.

Phone: (561)369-2144
Fax:   (561)244-6135

Or you may email the pharmacist at:

pharmacist@drquinonez.com

Disclaimer.
This is only a request for a prescription refill. When your refill request has been approved, you will receive a confirmation email.

Please call your pharmacy before picking up your prescription(s).

If you have not received an email confirmation in 2-3 business days, please call us at the above number.

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