Before filling the refill request form:

  • – Make sure there are no refills left on the prescription you are requesting.
  • – Once approved by your doctor, your prescription will be sent to your pharmacy within 24 hours.
  • – You will be contacted by us only if there is a problem with your refill.
  • – For any questions regarding the completion of your refill please contact your pharmacy 24 hours after you have made your request.
  • – Prescriptions will not be sent in on weekends or holidays.

If you have not been to Tribeca Skin Center within the last 12 months, you will need to call the office for an appointment at 212-334-3774 during normal business hours or request an appointment through our online form.

This form is for prescription refill request only. If you have any other questions, please call or email us.

    First Name *

    Last Name *

    Date of Birth * (mm/dd/yyyy)

    Phone *

    Email*

    Pharmacy Phone * (not your phone number)

    Name of Medication(s)* Separate by commas. If you are unsure of the name, please describe what you are using it for. We will contact you if we need further information.

    By clicking Send, you are initiating an email to Tribeca Skin Center. Email is not a secure form of communication.