Prescription Refills

PLEASE NOTE:
Medication refills are available for Dr. De Klerk, Dr. Soni, Dr. Salvador and Dr. Salvador’s patients. If you are not a patient of these doctors, please schedule an appointment with your primary care physician for prescription refills. Thank you for being so cooperative.

Your Name

First Name

Last Name

Your Email

Your Prescription Refill Details. IN FULL PLEASE:

Please include the following for each medication. 1-Name of medication: 2-Medication dose: (eg. 10mg, 50g etc.) 3-How often it is taken: (eg. once, twice) 4-How is it administered: (eg. oral, rectal, topical etc.) 5-Pharmacy Name and Location: