Prescription Refill Requests.

Your Full Name *
Date of Birth *
Medication Name/Dose *
Med Instructions/ (Number of Times Taken Each Day) *
Precribing Doctor *	----Dr. AquinoDr. HartrichDr. HrabDr. HeydenDr. ThiermanDr. Riedy
Pharmacy Name/Telephone Number *
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Please be aware prescriptions may take up to 48 hours to send into your pharmacy. 

If in need of an urgent prescription, please call the office at (716)634-5410 prompt 4.