Use the following online Prescription Refill form to request a refill of your current prescription. Upon receipt of this request, an authorized nurse will call you to confirm and finalize the request. * denotes a required field * Patient Name:  * Phone #:  * Date of Birth:   (Please use mm/dd/yy format.) Pharmacy Name:  Prescription #:  * Physician:  [ Select Your Physician ]  Dr. Ali Akbary Dr. H. Barrett (Barry) Cheek Richard Costello Dr. Malkiat S. Dhatt Dr. Robert A. Erdin Cynthia Ferguson Dr. Thomas G. Folk Tom Freeman Dr. Ernest Gumprecht Dr. Robert J. Krasowski Dr. Kathryn A McFarland Dr. James R. McGukin Dr. Brian J. Munley Dr. Rajan Revankar Dr. Steven C. Rohrbeck Ben Strag Dr. Zan Tyson Dr. Chandra Vyas Dr. Kenneth Wallmeyer * Location:  [ Select Your Location ]  Asheboro-Fayetteville Asheboro-White Oak High Point Lexington Thomasville * Medication:  Please indicate your medication here and any additional information pertaining to this request. You will be contacted by an authorized staff representative.