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Re-Order Prescriptions
To refill a prescription that you filled with AAPEX pharmacy previously, please complete the form below and enter the prescription number. This can be found on the prescription label.
Patient Information
First Name:
Last Name:
Phone:  --
Please check one of the boxes below:
Same address as before.
Please mail my prescription to the address below. (Note that we can not mail prescriptions to P.O boxes):
Address:
City:
State:  Zip: 
 
Fill Prescription information
  Rx # Example Medication Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Automatic Refills in Future:
   Yes:     No:   
Review your request and click "Send" button
   
 
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