For your pharmacy

Send us a refill authorization request

Pharmacies can fax the request using the cover sheet below, or fill the same cover sheet in on this page and send it to us online — no fax machine needed.

Ondoc fax number

+1 (844) 444-0573

Three steps for your pharmacist

1Fax the refill authorization to +1 (844) 444-0573 with the cover sheet below — or fill the cover sheet in below and press Send request online.
2Include patient DOB, medication, strength, directions, quantity, and refills requested.
3A licensed provider reviews the request and responds by fax.

Patients — submit your request first

We can only process pharmacy-initiated requests for patients who have an approved request on file. Submit your request below — no payment required until your request is approved — so we can match the incoming request to your account.

Ondoc

Refill Authorization Request

Fill this in to send it online, or print it blank and fax it.

Fax to

+1 (844) 444-0573

From (Pharmacy)

Pharmacy name *

Pharmacist

Phone

Fax

Patient

Full name *

Date of birth *

Phone *

Email *

Medication

Drug name & strength *

Directions (sig)

Quantity

Refills requested

Last fill date

Original Rx #

Notes for the provider

Or print this sheet and fax it to +1 (844) 444-0573.

This request may contain confidential health information protected by federal and state law. If you received this in error, please notify the sender and destroy all copies. Ondoc reviews routine, non-controlled refill requests only. For controlled substances or new prescriptions, please contact the patient's primary care provider.