Prescription Refill – American Medical Center

Request Prescription Refill

After sending this form, your prescription request will be processed and our team will have your prescription refill ready for pickup in 48 hours.

Refill pickups are available from Monday-Thursday between 04:00PM - 05:00PM and Friday between 11:00AM - 12:00PM.

Prescription Refill

Refill Request Form

General Information

Title

First Name

Last Name

Date of Birth

Phone/Mobile

I confirm that I am not a new patient and this service is only for established patients

Medical Information

Name of Medication and Dose

Required

Would you like to pick up your medication at an American or German pharmacy?

American

German

Do you have any allergies?

Confirm & Request

Additional information

I consent to having this website store my submitted information so they can respond to my inquiry

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The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.

Request Prescription Refill

Refill Request Form

General Information

Medical Information

Confirm & Request

Any questions?

Links

Medical Clinic