💊 Prescription Refill Request Generator

A template to help you ask for a medication refill — clearly and respectfully — when you’re running low or need to explain why it’s important.

🔍 What this tool is

This tool helps you write a refill request you can send to your doctor, clinic, or care team. It’s helpful when you’re low on medication, switching providers, or facing an insurance delay.

You can use it for yourself or to help a loved one. We’ll guide you through what to include — you don’t need perfect wording or medical terms.

• 🔒 Private by design
  Everything you write stays on your device. It’s never saved, sent, or tracked.
• 🩺 Not medical advice
  This is a writing tool — not a prescription service or substitute for professional care.

🛠️ Ready to begin? Jump to the form

📝 Example output

Hi,

I'm writing to request a refill for Sertraline 50mg, which I’ve been taking for about 8 months. It’s been helpful in managing my anxiety symptoms, and I’m running low.

I have a follow-up appointment in two weeks but may run out before then.

Thanks so much,  
Jordan Reyes

📋 Generated Request

You can copy, print, or share this message — whatever works best.