Refill Prescription — Alice Chen Pharmacy

Patient Information

Patient Full Name *

Date of Birth *

Phone Number *

Prescription Details

Rx Number (if known)

Medication Name *

Prescriber Name

Pickup Preference

I'll pick up in store Free delivery (Flushing area)

I confirm this refill request is for a current, valid prescription and authorize Alice Chen Pharmacy to process it. *

Refill request submitted!
We'll notify you when your prescription is ready. Most refills are ready within 2 hours.