By submitting this refill request, you acknowledge and agree to the following terms:
Identity Verification & Authorization
I hereby attest and confirm that:
- I am the patient for the prescription(s) being requested
- The information provided (including date of birth and prescription numbers) is accurate and belongs to me
- I am authorized to request this refill
- I understand that providing false information is a violation of law and pharmacy policy
No Guarantee of Refill or Timing
Submission of a refill request does not guarantee that your prescription will be refilled, filled by a specific time, or available for pickup/delivery on a specific date.
Verification Required
All refill requests are subject to verification, including:
- Valid prescription on file
- Prescriber authorization and refill authorization status
- Pharmacy review for clinical appropriateness
- Insurance eligibility and approval
- Patient identity and date of birth verification
Not for Urgent or Emergency Needs
This refill request tool is for routine refills only. If you require immediate assistance, contact the pharmacy directly or seek medical care.
Processing Times
Refill requests received outside normal business hours will be processed on the next business day. Balbonis Pharmacy is not responsible for delays caused by prescriber response times, insurance authorization, supply shortages, or incomplete information.
Authorization to Access Records
By submitting this request, you authorize the pharmacy to access and review your prescription, medication, and insurance records as necessary to process the refill.
Privacy and Data Security
Information submitted is processed in accordance with applicable privacy laws and our Privacy Policy.
Independence of Professional Judgment
A licensed pharmacist may refuse to refill a prescription if, in their professional judgment, it would be unsafe or inappropriate to do so.
