Request a Prescription Refill

Fill out the form below and we'll have your prescription ready for pickup at our Apple Valley location.

Simple Process

How It Works

Fill Out the Form

Enter your patient info and prescription details in the form below. Takes about 2 minutes.

We Process Your Request

Our team reviews your refill request and prepares your medication. We'll contact you if we have any questions.

Pick Up In-Store

Come to 17798 Highway 18, Apple Valley to pick up your prescription when it's ready.

Prefer to call? Reach us at 760-242-4900 during business hours and we'll take your refill request by phone.

Online Refill Request

Refill Request Form

Fields marked with asterisk are required.

This form submits a refill request to our pharmacy team. It does not guarantee same-day availability. We will contact you when your prescription is ready for pickup.

Online refill form coming soon.

Please reach us directly in the meantime:

760-242-4900 | RanchoDrugsRx@gmail.com

Patient Information

Full Name

Date of Birth

Phone Number Format: 760-555-0100

Prescription Information

Prescription Number Found on your prescription bottle label. Optional if you provide the medication name.

Medication Name

Additional Notes Optional — any special instructions or questions for our pharmacist team.

Preferred Contact Method

Phone Call Text Message No notification needed — I'll check in-store

Your information is kept confidential and used solely to process your refill request.

Rather speak with someone directly?

Call 760-242-4900 Contact Us