Prescription Refills Online

To refill prescription(s) online, simply complete the Refill Request form below (e-mail address is optional).
* INDICATES REQUIRED FIELD

* First Name: * Last Name:
* Phone Number: ( )
* E-mail Address:
Please enter the prescription number(s) from your prescription label (see sample below)
* Prescription #1
  Prescription #2
  Prescription #3
  Prescription #4
  Prescription #5
  Prescription #6
  Prescription #7
  Prescription #8

* How many birth control packs will you be requesting?
0 Birth Control Packs
1 Birth Control Pack1
2 Birth Control Packs
3 Birth Control Packs
4 Birth Control Packs
5 Birth control Packs
6 Birth Control Packs
7 Birth Control Packs
8 Birth Control Packs
University of Central Florida - Orlando
4000 Central Florida Blvd. Orlando, Fl 32816
Phone: (407) 823-6756
Phone: (407) 823-6337