Prescription Refills Online

To refill prescription(s) online, simply complete the Refill Request form below (e-mail address is optional)

* INDICATES REQUIRED FIELD

Patient Information:

 

* First Name:  * Last Name:
LAST NAME MUST BE ENTERED EXACTLY AS IT APPEARS ON THE PRESCRIPTION LABEL.
* Phone Number: () - E-mail Address:
NUMBER WHERE YOU CAN BE REACHED IF THE PHARMACIST HAS A QUESTION. REQUIRED ONLY IF YOU WISH TO RECEIVE AN EMAIL CONFIRMING YOUR ORDER WAS RECEIVED BY THE PHARMACY.

Prescription Information:

  Please enter the prescription number(s) you wish to refill at this time. This number is located on your prescription label (see example). If your prescription number starts with a letter, please use "7" for "R"; "2" for "C". If your prescription number starts with a "6" or "N", you will need to contact your prescriber directly. ALL PRESCRIPTIONS ENTERED MUST MATCH THE LAST NAME AS ENTERED ABOVE.
* Prescription #1
  Prescription #2
  Prescription #3
  Prescription #4
  Prescription #5
  Prescription #6
  Prescription #7
  Prescription #8

 
 
* Would you like the pharmacy to contact your doctor if your prescription needs authorization?
Yes    No
 
Pharmacy Hours
Monday-Friday 7am-7pm
Closed Weekends and Holidays
 
   
 
Overlake Medical Tower Pharmacy
1135 116th Avenue NE #105
Bellevue, WA 98004
Phone: (425) 688-5958
Fax: (425) 467-3540
Email: omtpharm@overlakehospital.org
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