Creekmore Clinic Family Practice - Providing Healthcare for the Entire Family home about us services medical staff insurance directions contact us

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Prescription Refill Request

To order refills online, complete the order form below. You will need your prescription number, which can be found on your original order's packing slip or on your prescription label.

This form is only for existing prescriptions filled by Creekmore Clinic. If your existing prescription indicates it was filled by another clinic or pharmacy, please call the phone number listed on your prescription.

*Full Name:
Contact Phone:
Pharmacy Name:
Drug Name:
Prescribing Physician: