New Prescription

Please do not use the form below if your doctor has provided you with a written prescription. Your doctor may not authorize a prescription over the phone if he/she has already written one out.
Simply bring the written prescription order to Riggs Medical Center to be filled if you’d like to pick it up.

Please complete the form below if your doctor requests that a pharmacist phone him/her for your new prescription, and has not provided you with a written prescription. We will use the information you provide to contact your doctor for authorization to fill your prescription. You may have your prescription shipped to you, or you may pick it up at your local Riggs Medical Center.

First Name: *	* Required
Last Name: *	* Required
Phone Number: *	* Required
Email Address: *	* Required
Doctor's First Name: *	* Required
Doctor's Last Name: *	* Required
Doctors Phone Number: *	* Required
Drug Name: *	* Required
Drug Strength:
Quantity:
Please provide any comments or special instructions:

Request New Prescription