We believe in convenience when it comes to refilling your prescriptions. At Corley's Pharmacy, we handle your prescriptions with the care that you've come to expect, so you can rest knowing that we've given you accurate medications and the correct quantity.

Also, if you plan to pick up your prescriptions, please bring a photo ID to our pharmacy. If you plan on having them delivered, you will need to sign for your medications on arrival.

Please fill out the form below for the quickest processing of your medical prescription. We will call you when they are ready.

* Indicates a required field.
 
*Name:   First:   Last:  
 
Prescriptions: *1. 6.
  2. 7.
  3. 8.
  4. 9.
  5. 10.
 
*Delivery Choice:    
 
In case we need to get hold of you.
 
*Phone Number: (123-456-7890)
*Email Address:
  (Note: Address information is required if you choose to mail your presciptions)
Address:
City:
State:   Zip:  
Please include any comments about your prescription refill:
 
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*Security Code:
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