Oasis Family Medicine

Medication Refill Request Form

Members Only

Please allow 2 business days for refills. You will receive a text when refills are ready for pick-up. Thank you!

* indicates required field

Name *

Email *

DOB *

Phone *

Address

Provider *

Medication Name #1 *

Dose *

Quantity *

Pick up? *

Medication Name #2

Dose

Quantity

Pick up?

Medication Name #3

Dose

Quantity

Pick up?

Medication Name #4

Dose

Quantity

Pick up?

Please list additional medications if needed. Be sure to include which pharmacy you prefer, if applicable.

Oasis Family Medicine

Monday-Friday

8:30am - 5:00pm

Saturday-Sunday

closed

For your urgent needs we are on call after hours and on weekends. Call us today at 785-286-6816.

Oasis Family Medicine AE

This is exclusively for Advisors Excel Employees
4123 Gage Center Drive
Suite 126
Topeka, KS 66604

Monday-Friday

8:30am - 5:00pm

Saturday-Sunday

closed

For after hours urgent needs call Hannah at 785-509-7886.