Oregon State University

Prescription Refill Request Form

The Student Health Services Pharmacy is pleased to accept your prescription refill requests over the Internet for prescriptions that are from the SHS Pharmacy using the form below. To transfer a prescription from another pharmacy, please call us during business hours, Monday through Friday, 9 am to 6 pm. Please note the following:

  • If your prescription has authorized refills remaining, we can fill it immediately. If there are no remaining refills authorized, we must contact your clinician, which will delay processing of your request.
  • Authorized and approved requests that are received before 1 PM will be filled that same working day. Requests received later than 1 PM will be processed the next working day.
  • Some requests may take as long as 24 hours
  • You MUST include your phone number and date of birth in the request form. Requests without phone numbers and date of birth will not be filled.
  • Please be prepared to present your student ID when you pick up your prescription.
Name: (First, MI, Last)
Date of Birth: (MM/DD/YY)
E-mail:
Your Local Phone #:
OSU Prescription Number or Description:
Number of refills requested:
How do you wish to pay for this refill?
Additional Instructions or Comments: