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Thrifty Script Plan
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Medicine Shoppe
66 West Avenue
Canandaigua, NY 14424
Toll Free: 1-800-396-9970
R E Q U E S T R E F I L L S
To request refills please fill in the information below and press
'Submit Refill Request'. Fields marked with * are required fields! Please fill them! Invalid refill requests will be ignored.
*Patient Name:
*Phone Number:
*E-mail Address:
When ?
Today
Tomorrow
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
What time ?
No Particular Time
10 AM
11 AM
NOON
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
*How ?
Pick up
UPS Ground
UPS Second Day
UPS Next Day
Priority Mail
Other (Specify in comments)
Prescription Number:
Medicine Name or Use:
*1.
2.
3.
4.
5.
6.
Additional Comments:
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