Prescription request

Refill a prescription

Request a refill online at any time. We process requests during business hours.

Prescription vials lined up on a kitchen counter

We check it with your planCoverage and cost are confirmed before we fill
We call if we need anythingDuring business hours, at the number you give us
Ready or on its wayPick up in Hicksville or get free delivery
Prefer to call?(516) 900-0636, Monday to Friday, 9 AM to 6 PM

Refill a prescription

Your prescription number is on your Statmeds label. If you don’t have it, enter the medication name.

Your health information is protected. What you send through this form is protected health information under HIPAA. It is sent over an encrypted connection to our pharmacy team and is used and disclosed as described in our Notice of Privacy Practices. Don’t use this form for emergencies or urgent medical questions. Call us at (516) 900-0636 or dial 911.

Patient

First name

Last name

Date of birth

Mobile phone We’ll call this number about your request. We text only if you opt in below.

Prescriptions to refill

Rx number or medication 1

Medication name (optional)

Pickup or delivery

How would you like to get your refill?

Free deliveryPick up in Hicksville

Needed by (optional)

Delivery address, if different from what we have on file (optional)

Notes for the pharmacy (optional)

I am the patient or legally authorized to act for the patient, and I acknowledge that I have received the Notice of Privacy Practices. Text me about my prescriptions (optional). By checking this box, I agree to receive recurring automated text messages from Statmeds Pharmacy (Duffy Rx LLC) at the mobile number I provided, including refill reminders, order and delivery status updates, and replies to my requests. Consent is not a condition of purchase or service. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. Text messages aren’t encrypted, so we keep health details in them to a minimum. See our Privacy Policy and Terms of Service.

Fields marked * are required.

Refill a prescription

Refill a prescription

For prescribers and office staff