Patient Resources

Rx Refill Request

Submit your refill request below and our team will take it from there. We'll reach out via text or phone to confirm your order and arrange free delivery anywhere in Oklahoma.

HIPAA Notice

By submitting this form, you acknowledge that you are providing Protected Health Information (PHI) so that Bristol Pharmacy can process your prescription refill request. The information you submit is transmitted directly to a HIPAA-compliant pharmacy email account and is accessed only by authorized pharmacy personnel. If you prefer not to send PHI electronically, please call the pharmacy at (405) 451-0777 to request your refill.

Patient Information

Fields marked with an asterisk are required.

First Name

Last Name

Date of Birth

Phone

10 digits, including area code. We'll text or call this number to confirm your order.

Rx Number

Optional — enter multiple Rx numbers separated by commas.

Name of Medication(s)

Optional — list the medications you'd like refilled.

This online form needs JavaScript. To request your refill without it, call us at (405) 451-0777 — Mon–Fri, 9 AM – 5 PM CST.

On the live site this form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Your information is submitted securely over HTTPS and sent directly to our pharmacy team. View our HIPAA Notice.

Other Ways to Request a Refill

NimbleRx

Request refills directly through the NimbleRx patient portal or app.

Open NimbleRx (opens in a new tab) →

Call or Fax

Phone: (405) 451-0777
Fax: (405) 451-0778
Mon–Fri, 9 AM – 5 PM CST

Text Us

Reply to any text from us or use the direct phone number found on your Rx label.

HIPAA Notice

Patient Information

Please fix the following:

NimbleRx

Call or Fax

Text Us