Hours of Operation : Monday - Friday - 8:00am - 5:00pm

Call Us 239.596.0100

Request Prescription Refill

Use this form to request a prescription refill for a non-narcotic prescription. Please allow 48 hours to process your prescription refill. We will notify you when your prescription has been called into your pharmacy.

Dr. Zehr is happy to refill any prescription that he originally wrote in his treatment of you. He will not, unfortunately, be able to refill prescriptions written for you by other physicians as this is bad medicine and potentially very dangerous to you.

Patient Information


MM/DD/YYYY


(if other than the patient)

Prescription Information

(e.g. Prevacid)

(e.g. 30 mg/once a day)

(e.g. 60)


Note: Please enter the Security Code as shown above to submit the form.


Please allow 24-48 hours (excluding weekends) for your prescription refill request to be processed. We ask that you request your medications at least 3 to 4 days before your prescription is due to run out. We will refill prescriptions that are current only (prescribed within the last 3 months).

Contact Us or Call 239.596.0100 Today

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