• Address:2321 Coronado Street
    Idaho Falls, ID 83404
  • Phone:(208) 227-1100

Please allow 24-48 hours for refill processing. If this refill is more urgent, please call the office at 208-227-1100

Prescription Refill Form

Patient's Full Name
Date Of Birth
Gender
Summit Provider
Daytime Phone Number
Other Phone Number
Email Address

Medication 1

Medication 1: Name
Medication 1: Dosage
Medication 1: Frequency
Medication 1: Days Supply Requested

Medication 2

Medication 2: Name
Medication 2: Dosage
Medication 2: Frequency
Medication 2: Days Supply Requested

Medication 3

Medication 3: Name
Medication 3: Dosage
Medication 3: Frequency
Medication 3: Days Supply Requested

 

Preferred Pickup Location
If Pharmacy, please enter pharmacy name:
If Pharmacy, please enter pharmacy address:
If Pharmacy, please enter pharmacy phone:

 

Submit Form 

Patient Testimonials

"[Dr. West] is friendly and caring,with an excellent bedside manner. He nspires trust. I felt well cared for throughout these ordeals, and am very well pleased with my knee replacements. My life has been very much improved as a result of his skill and good care."
- anonymous patient review