•  CLINIC: (607) 330-1254
  •  OFFICE: (607) 330-1253
  •   Walk-in Clinic Hours: Mon. 2-6pm Th. 4-7pm

Refill Requests During COVID-19 Pandemic

Prescription Refill

If you are a current patient (active within the last 12 months) at the Ithaca Free Clinic, we will be honoring prescription refills during this difficult time.

Please fill out the form below and wait to be contacted via email. If there are questions we will email you, and once submitted for refill, we will notify you of completion. Thank you.

First Name:

Last Name:

Date of Birth:

Phone: #

Email:

Pharmacy:
Name of Prescription Medication:

Additional Info: