Patient Information Form

Address:

Easily refill your medications

Call or text us for refills. We also provide courtesy refills calls before the next fill.

Get clinical support

Speak to a Pharmacist regarding your medication questions

CURRENT MEDICATIONS:

DRUG ALLERGIES:

info@lakeridgepharmacy.com

(972) 522 - 7606 Toll free (866) 588 - 7606

Email:

Phone:

Get your medication when you need it

We can deliver your medication straight to your door.

Afford your medication

We seek financial assistance on your behalf.

Patient Information Form

Comments/Questions:

INSURANCE

Name: *