Please fill out the form below. The items with an asterisk (*) are required in order to process your refill request. Requests will be processed within 4 hours (during business hours). Requests received after 12:30 pm will be ready at 9:00am the following business day. Bring your Student ID and fill out a Pharmacy invoice when you come in to pick up your refill(s).
If you fail to pick up your refill within 7 days, it will be canceled and you will be required to re-order your refill request. Questions can be directed to the Pharmacy by calling 815-753-9706.
Please note that information submitted over the Internet is not 100% secure and may be viewed by third parties.
