Provide the following information necessary to process refills at the UNT Pharmacy. Please allow one working day for processing your order(s). All prescriptions and refills must be picked up within 7 working days or they will be discarded. It is your responsibility to make sure your prescriptions are picked up in a timely manner. If there are problems regarding the refill(s) we will try to contact you by phone.

Prescriptions to be transferred from other pharmacies must be carried out in person at the UNT Pharmacy.

In order to verify the identity of the individual picking up the prescription, you will be required to present your ID, and insurance card at the check-in windows.

If you have more that one refill request, you will be given the option to fill out another one after you submit the first. When submitting more than one refill, make sure to recheck the box to be notified via email for each refill, because you will only receive one confirmation per refill request.

Last Name:

First Name:
(Name as appears on current school records)

Email :   

Contact Phone (format: XXX-XXX-XXXX):

Prescription Number: (What is my prescription number?)

Refills Desired:

Special instructions (optional):

Pick-Up Date: -- mm/dd/yyyy

Notification: If you would like to be notified by email when your refill is ready, please check this box.

For problems email Kerry Stanhope. Do not email questions dealing with personal medical help - Thank you.