This form is for requesting a refill on a medication that you have already been prescribed. Requests submitted will be phoned into the pharmacy within 1 business day and an e-mail confirmartion will be sent when this has been done. If the nurse has questions about your request a phone call will be placed within one business day. If, for some reason, you do not receive a reply within that time period, please call our office at (260) 432-5005 or toll-free at (800) 496-3889 and ask for the phone nurse. Thank you.