Prescription Refills

Convenient and easy Rx refills

Click here if you are a new patient. If you are a returning patient, simply enter your prescription information below. If you are an existing patient and your prescription is NEW, it must be faxed to us by your Doctor to (201) 891-6392. Once we have your prescription on file, you may use this form to order refills.

Have you been notified that your pharmacy may stop accepting your Express Scripts Insurance?

We can help! ALL T&F Pharmacies Welcome Express Scripts members! We accept ALL Express Scripts Insurance plans. Each of our stores offer affordable and convenient ways to fill existing and new prescriptions.

1. Contact Details

2. First Namerequired
3. Last Namerequired
4. Emailemail required
5. Phonerequired
6. Which location would you like to pickup your prescription from? Sicomac De Blieck's Ho-Ho-Kus
7. If the prescription is for another family member, please specify their first name.
8. 1. Rx No
9. 1. Name
10. 2. Rx No
11. 2. Name
12. 3. Rx No
13. 3. Name
14. 4. Rx No
15. 4. Name
16. 5. Rx No
17. 5. Name
18. Please specify approximate pick-up time: (Allow at least 2 hours.)required
19. ADDITIONAL ITEMS, COMMENTS OR CHANGES:

 

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