Virtual Urgent Care

Prescription request.

Non-controlled medications only · Reviewed by your PA-C · Florida residents

We do not prescribe controlled substances (opioids, benzodiazepines, stimulants, etc.) via telehealth. For medical emergencies, call 911.

Request Details

Request type

Medication name

Dose / strength

Quantity / supply

Reason for request (symptoms, diagnosis, or why a refill is needed)

When did you last take this medication? (optional)

Preferred Pharmacy

Pharmacy name

Pharmacy address (city, state, ZIP)

Pharmacy phone

Past Medical History

Have you been diagnosed with any of the following?

Other relevant conditions, surgeries, or hospitalizations (optional)

Sex assigned at birth

Current Medications

I do not currently take any medications or supplements.

Allergies

No known allergies.

Additional Notes & Consent

Anything else your provider should know? (optional)

I understand this clinic does not prescribe controlled substances via telehealth.The information I provided above is accurate and complete to the best of my knowledge.I consent to be contacted electronically about this request and to electronic prescribing to my pharmacy.