Lakeside Pharmacy is happy to offer prescription refill requests from our website. Fill out the appropriate fields below and we'll take it from there. Please allow 24 hours for our FREE DELIVERY service to bring your prescription to you if submitted after our normal store hours. Same day delivery is available in most cases. Prescriptions to be picked up will be ready shortly if submitted during our regular store hours.

Patient's Name:
Patient's Home Phone:
Patient's Work Phone:
Patient's Cell Phone:
Patient's Address:
City, State, Zip:
Email Address:
Delivery: Choose from Below Yes, Please Deliver No, I'll Pick it Up
What Time:

Please complete the following information for each prescription to be refilled by Lakeside Pharmacy:

First Prescription Number:
Second Prescription Number:
Third Prescription Number:
Fourth Prescription Number:
Fifth Prescription Number:
Sixth Prescription Number: