Skip to main content.
University of North Dakota Home
UND Student Health Services
UND Home'UND Student Health Services Home'Contact Us 'A Unit of the Division of Student Services
'
SEARCH UND
A to Z Index'Directory'Map
INFORMATION
Appointment & Hours
Forms
Care Eligibility
Immunization Requirements
Billing Information
Special Needs
Rights & Responsiblilities
Privacy Practices & Confidentiality
SERVICES
General Medical Care
Laboratory and X-ray
Pharmacy
Immunizations
Allergy Injections
Flight Physicals
Women's Health Care
Men's Health Care
Dietitian
Tobacco Cessation
Travel Consults
Self Care Station
Sexual Health
Eating Disorders
Interdisciplinary Team
SHS STAFF
FAQ
TOP 20 HEALTH ISSUES
HEALTH PROMOTION
WELLNESS
Links
CONTACT US
 
 
 
'
UND Student Health Services
 
Online Prescription Refill Request
 

Please provide the following contact information:

Full Name:
Student ID#:
Phone#:
E-Mail:
Please provide the following prescription information:
1) Name and Strength of Medication:
Please enter name and strength of medication
  Rx# (upper left corner of label)
  Quantity of medication:
Additional Prescriptions:
2) Name and Strength of Medication:
  Rx# (upper left corner of label)
  Quantity of medication:
     
3) Name and Strength of Medication:
  Rx# (upper left corner of label)
  Quantity of medication:
     
4) Name and Strength of Medication:
  Rx# (upper left corner of label)
  Quantity of medication:
     
5) Name and Strength of Medication:
  Rx# (upper left corner of label)
  Quantity of medication:
I understand that every effort has been made to ensure my privacy,
but full confidentiality cannot yet be guaranteed in an electronic medium.
Indicate understanding/acceptance.

 

 
 
UND Home'UND Student Health Services Home Page'Student Health Services Contact Page
MyUND'A to Z Index'Contact UND' 'Return to Top
University of North Dakota • ©2022 University of North Dakota. Send questions/comments about this web site to the .

UND Student Health Services
McCannel Hall, Room 100
Box 9038
Grand Forks, ND 58202
Tel: 701.777.4500
Email: