Request your RX Refill Online

Your Request submitted through this form will be processed within 24 to 48 hours.

  • If you need a refill today, please phone our office between 8:30am and 4:30pm at 864-833-5986.
  • Return phone calls from the nurse or physician will be made around mid-day and again after 4:30pm.
  • Call-in prescriptions and phone consultations with physicians, both during and after office hours, may involve a fee for medical decision-making services.

Please Note: This form applies only to medications that have previously been prescribed by the physicians of The Family Healthcare Center. If you are inquiring about a new medication, please consult your physician.

PATIENT INFORMATION
First Name Last Name
Home Phone Work Phone
Cell Phone Email
Date of Birth Gender
PERSON COMPLETING THIS FORM (IF OTHER THAN PATIENT)
Name Relationship
Provider
Where should we send your prescription?
Choose Pharmacy from this list
Other Pharmacy Other Pharmacy Phone
Was your prescription filled here the last time?
RX Information
First Request
Medication Taken Dosage
RX Number Notes
Second Request
Medication Taken Dosage
RX Number Notes
Third Request
Medication Taken Dosage
RX Number Notes
RX Refill Notes
Recheck all information before submitting.
Phone: 833-5986

Address:
23013 Hwy. 76
Clinton, SC 29325

Summer Office hours:
May-July 2007
Mon. 7:30am-7pm
Tues.- Fri. 7:30am-5pm
Sat. - 9am - 11am

If you need assistance after normal office hours, call the Laurens County Hospital at 833-9100 and have our on-call physician paged.

IN AN EMERGENCY

If you are experiencing severe shortness of breath, chest pain, uncontrollable bleeding, or any other emergency situation, please seek treatment at Laurens County Hospital before attempting to call us.

Laurens County EMS can be reached by calling 911.