Scott & White Prescription Refill/Transfer Form

Pick-up of online refills requested through the Scott & White Prescription Refill Form are only available at S&W Out-Patient Pharmacy and S&W Pediatric Pharmacy.

To request a refill at another S&W pharmacy, please visit:

Mail-out of online refills is available to any customer who has a credit card on file at the S&W Express mail-out pharmacy.

If you experience a problem with your refill, please notify us immediately either by the comment page or by contacting your pharmacy.

If you would like to file a complaint, please see How to File a Complaint Against a Pharmacy or Pharmacist to learn how to contact the Texas State Board of Pharmacy.

Your Information
Name: Birthdate:
Email: Daytime Phone:
The Daytime Phone number will be used only if questions arise concerning your prescription.  Bold Print indicates required information.

Your Prescription Information
Patient Name
(if different from above)
Pharmacy where prescription was last filled

Name if other

Pharmacy Phone Number

Your prescription(s) will be filled at the Scott & White Pharmacy
you select in step 3.

If your Doctor has changed your prescription since your last refill, please indicate the changes below:
If different from Prescription Label.
Special Instructions:

Select how you would like to receive your prescription.
Pick Up
Mail Out
We accept all major credit cards, checks and cash, when you pick up your prescriptions.  All mail orders will be charged to the credit card you have on file with the S&W Express mail-out pharmacy.
Where would you like to pick up your refills?

Please allow at least 24 hours.
Thank you.

Do not see your pharmacy?

Request your refill here:
Please let us know where you would like us to ship your refill(s).


Please allow 7-10 business days for delivery.
Thank you.

If the prescription is expired or needs physician intervention, please allow an additional 72 hours for refills.