Please complete this form and submit 24 hours prior to planned pick-up. For urgent
orders, please call in order to (321) 726-1614.
If you do not need a refill, but have a question or comment for the pharmacy, call
or e-mail us.
If you need a refill, please make sure that your bottle indicates refills remaining,
otherwise, please contact your physician for authorization for a refill.
If you would like to attach a scan of a new prescription, please e-mail us. *You must present the original prescription at the pharmacy in order to receive this medication.
HFMC Pharmacy Refill Form
Be aware that e-mail may generally not provide the same level of confidentiality
as telephone or U.S. mail communications. Your e-mails will be printed out by HFMC
staff, attached to your chart, and placed on the desk of the person to whom they
are directed. Generally, this aspect of the communications is secure from outside
eyes, but diversion could occur via the ISP or through e-mail monitoring by network
supervisors, so keep that in mind anytime you send anyone an e-mail.