Prescription refills

This form is a front-end shell. Connect to your backend for PHI handling, e-prescribe lookup, and secure prescription image upload.

Full Name

Date of birth

Phone Number

Email

Request type

Transfer to Loving Care

Move your prescription from another pharmacy. We will coordinate the transfer.

Recommended

Refill here

Request a refill for a prescription already on file at Loving Care.

Rx Number(s) and Medication Name(s)

+ Add another

Current Pharmacy Name

Current Pharmacy Phone

Verify you are human

Type the characters shown in the image (not case-sensitive).

New image

We can transfer prescriptions from your current pharmacy or refill existing Loving Care prescriptions.

I confirm this is a refill request for an existing prescription

This secure form submits directly to our pharmacy team over HTTPS.

Submit Request