{"id":139,"date":"2025-07-26T14:13:10","date_gmt":"2025-07-26T14:13:10","guid":{"rendered":"https:\/\/pineislandrx.com\/?page_id=139"},"modified":"2025-09-16T16:49:49","modified_gmt":"2025-09-16T16:49:49","slug":"refill-request","status":"publish","type":"page","link":"https:\/\/pineislandrx.com\/es\/refill-request\/","title":{"rendered":"Ordene su Repetici\u00f3n"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"139\" class=\"elementor elementor-139\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5a2e958 e-con-full e-flex e-con e-parent\" data-id=\"5a2e958\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-11170585 e-flex e-con-boxed e-con e-child\" data-id=\"11170585\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-660e364b elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"660e364b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeIn&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Refill Prescription Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-43f0f48d e-flex e-con-boxed e-con e-parent\" data-id=\"43f0f48d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-040c3bd e-con-full e-flex e-con e-child\" data-id=\"040c3bd\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7c5c829 elementor-align-start elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-invisible elementor-widget elementor-widget-icon-list\" data-id=\"7c5c829\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInLeft&quot;}\" data-widget_type=\"icon-list.default\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-pills\" viewBox=\"0 0 576 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M112 32C50.1 32 0 82.1 0 144v224c0 61.9 50.1 112 112 112s112-50.1 112-112V144c0-61.9-50.1-112-112-112zm48 224H64V144c0-26.5 21.5-48 48-48s48 21.5 48 48v112zm139.7-29.7c-3.5-3.5-9.4-3.1-12.3.8-45.3 62.5-40.4 150.1 15.9 206.4 56.3 56.3 143.9 61.2 206.4 15.9 4-2.9 4.3-8.8.8-12.3L299.7 226.3zm229.8-19c-56.3-56.3-143.9-61.2-206.4-15.9-4 2.9-4.3 8.8-.8 12.3l210.8 210.8c3.5 3.5 9.4 3.1 12.3-.8 45.3-62.6 40.5-150.1-15.9-206.4z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Focused on What Matters: Your Health<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e23c733 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"e23c733\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInLeft&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Get Your Medications On Time<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8d60b02 elementor-invisible elementor-widget elementor-widget-text-editor\" data-id=\"8d60b02\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInLeft&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Easily request a refill for your medications using the form below. <br \/>Just fill in your information, select your delivery method, and we\u2019ll take care of the rest. Your health and convenience are our priority.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-4537ff33 e-con-full e-flex elementor-invisible e-con e-child\" data-id=\"4537ff33\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeInRight&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-45934453 elementor-widget elementor-widget-rform\" data-id=\"45934453\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t            <form id=\"rform\" data-form=\"223\">\r\n                <div class=\"require-login msg\">\r\n                    <div class=\"require-msg-body\">\r\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"35\" height=\"35\" fill=\"#FF0000\" class=\"bi bi-exclamation-circle-fill\" viewBox=\"0 0 16 16\">\r\n                            <path d=\"M16 8A8 8 0 1 1 0 8a8 8 0 0 1 16 0zM8 4a.905.905 0 0 0-.9.995l.35 3.507a.552.552 0 0 0 1.1 0l.35-3.507A.905.905 0 0 0 8 4zm.002 6a1 1 0 1 0 0 2 1 1 0 0 0 0-2z\" \/>\r\n                        <\/svg>\r\n                        <div style=\"width: 100% ;\">\r\n                            <h5 class=\"required-title\">Required Login<\/h5>\r\n                            Please Login for Submit Form.\r\n                        <\/div>\r\n                        <div>\r\n                            <a type=\"button\" class=\"close-msg\">Close<\/a>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <div class=\"success-submit msg\"\r\n                    >\r\n                    <div class=\"success-body\">\r\n                        <svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"35\" height=\"35\" class=\"bi bi-check-circle-fill success-icon\" viewBox=\"0 0 16 16\">\r\n                            <path d=\"M16 8A8 8 0 1 1 0 8a8 8 0 0 1 16 0zm-3.97-3.03a.75.75 0 0 0-1.08.022L7.477 9.417 5.384 7.323a.75.75 0 0 0-1.06 1.06L6.97 11.03a.75.75 0 0 0 1.079-.02l3.992-4.99a.75.75 0 0 0-.01-1.05z\" \/>\r\n                        <\/svg>\r\n                        <div style=\"width: 100%;\">\r\n                            <h5 class=\"success-title\">Success<\/h5>\r\n                            <p class=\"success-description\">\r\n                                Thank you for your request! We\u2019ve received your prescription refill form and our team will begin processing it shortly. We\u2019ll contact you if any additional information is needed.                            <\/p>\r\n                        <\/div>\r\n                        <div>\r\n                            <button class=\"close-msg\"><\/button>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n                <style>.elementor-223 .elementor-element.elementor-element-5bd09b6d{--display:flex;--flex-direction:column;--container-widget-width:100%;--container-widget-height:initial;--container-widget-flex-grow:0;--container-widget-align-self:initial;--flex-wrap-mobile:wrap;}.elementor-223 .elementor-element.elementor-element-f3022d5{--display:flex;}.elementor-223 .elementor-element.elementor-element-1ded96b{--display:flex;--flex-direction:row;--container-widget-width:initial;--container-widget-height:100%;--container-widget-flex-grow:1;--container-widget-align-self:stretch;--flex-wrap-mobile:wrap;}.elementor-223 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--e-global-typography-accent-font-weight );line-height:var( --e-global-typography-accent-line-height );color:var( --e-global-color-accent );}.elementor-223 .elementor-element.elementor-element-42c7e680 #loading{border-top-color:var( --e-global-color-accent );}.elementor-223 .elementor-element.elementor-element-42c7e680 .rform-button-submit {background-color:var( --e-global-color-secondary );}@media(max-width:1024px){.elementor-223 .elementor-element.elementor-element-42c7e680 .rform-button-submit{font-size:var( --e-global-typography-accent-font-size );line-height:var( --e-global-typography-accent-line-height );}}@media(max-width:767px){.elementor-223 .elementor-element.elementor-element-ff9dc20{text-align:center;}.elementor-223 .elementor-element.elementor-element-332e1f70{--container-widget-width:100%;--container-widget-flex-grow:0;width:var( --container-widget-width, 100% );max-width:100%;}.elementor-223 .elementor-element.elementor-element-cdc5f81{--container-widget-width:100%;--container-widget-flex-grow:0;width:var( --container-widget-width, 100% );max-width:100%;}.elementor-223 .elementor-element.elementor-element-fe560e2{--container-widget-width:100%;--container-widget-flex-grow:0;width:var( --container-widget-width, 100% );max-width:100%;}.elementor-223 .elementor-element.elementor-element-8b66a79{text-align:center;}.elementor-223 .elementor-element.elementor-element-f29d75e{text-align:center;}.elementor-223 .elementor-element.elementor-element-f87f849{text-align:center;}.elementor-223 .elementor-element.elementor-element-42c7e680 .rform-button-submit{font-size:var( --e-global-typography-accent-font-size );line-height:var( --e-global-typography-accent-line-height );}}\/* Start custom CSS for rform_phone, class: .elementor-element-cdc5f81 *\/.iti__flag-container {\r\n  visibility: hidden !important;width: 0 !important;\r\n}.iti input {\r\n  padding-left: 32px !important; \r\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"223\" class=\"elementor elementor-223\" data-elementor-post-type=\"romethemeform_form\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5bd09b6d e-flex e-con-boxed e-con e-parent\" data-id=\"5bd09b6d\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-f3022d5 e-con-full e-flex e-con e-child\" data-id=\"f3022d5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ff9dc20 elementor-widget elementor-widget-heading\" data-id=\"ff9dc20\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Who is this prescription for?<\/h4>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1ded96b e-con-full e-flex e-con e-child\" data-id=\"1ded96b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-332e1f70 elementor-widget__width-initial elementor-widget elementor-widget-text\" data-id=\"332e1f70\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-858660720\">\r\n                        Name                        <span> * <\/span>                    <\/label>\r\n                                <input name=\"Name\" placeholder=\"Name\" class=\"rform-input\" id=\"rform-input-text-858660720\" type=\"text\" onblur=\"validate_input( 'rform-input-text-' , 'rform-input-err-' ,'858660720')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-858660720\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e3142ed elementor-widget__width-initial elementor-widget elementor-widget-text\" data-id=\"e3142ed\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-text-238109421\">\r\n                        Last name                        <span> * <\/span>                    <\/label>\r\n                                <input name=\"Last name\" placeholder=\"Last name\" class=\"rform-input\" id=\"rform-input-text-238109421\" type=\"text\" onblur=\"validate_input( 'rform-input-text-' , 'rform-input-err-' ,'238109421')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-238109421\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-6d708c0e e-con-full e-flex e-con e-child\" data-id=\"6d708c0e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-cdc5f81 elementor-widget__width-initial elementor-widget elementor-widget-rform_phone\" data-id=\"cdc5f81\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform_phone.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-tel-215768961\">\r\n                        Phone Number                        <span> * <\/span>                    <\/label>\r\n                                <input data-default-countries=\"US\" name=\"Phone Number\" placeholder=\"Phone Number\" class=\"rform-input-tel\" id=\"rform-input-tel-215768961\" type=\"tel\" onblur=\"validate_input( 'rform-input-tel-' , 'rform-input-err-' ,'215768961')\" aria-invalid=false required oninput=\"this.value = this.value.replace(\/[^0-9.]\/g, '').replace(\/(\\..*?)\\..*\/g, '$1');\">\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-215768961\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fe560e2 elementor-widget__width-initial elementor-widget elementor-widget-email\" data-id=\"fe560e2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"email.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control rform-label-top\">\r\n                                    <label class=\"rform-label-input\" for=\"rform-input-email-266690786\">\r\n                        Email                        <span> * <\/span>                    <\/label>\r\n                                <input name=\"Email\" placeholder=\"Email\" class=\"rform-input\" id=\"rform-input-email-266690786\" type=\"email\" onblur=\"validate_input( 'rform-input-email-' , 'rform-input-err-' ,'266690786')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-266690786\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-73114f1 e-con-full e-flex e-con e-child\" data-id=\"73114f1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8b66a79 elementor-widget elementor-widget-heading\" data-id=\"8b66a79\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Prescription numbers or medication names<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d05dd41 elementor-widget elementor-widget-text\" data-id=\"d05dd41\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control \">\r\n                                <input name=\"Prescription numbers or medication names\" placeholder=\"Prescription numbers or medication names\" class=\"rform-input\" id=\"rform-input-text-218488129\" type=\"text\" onblur=\"validate_input( 'rform-input-text-' , 'rform-input-err-' ,'218488129')\" aria-invalid=false data-val=\"by_char\"   required>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-218488129\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f29d75e elementor-widget elementor-widget-heading\" data-id=\"f29d75e\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">How would you like to receive your order?<\/h4>\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b57a8a2 e-con-full e-flex e-con e-child\" data-id=\"b57a8a2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c35f3d4 elementor-widget__width-inherit elementor-widget elementor-widget-select\" data-id=\"c35f3d4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"select.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control \">\r\n                                <div class=\"rform-select-container\">\r\n                    <div class=\"rform-select-div\">\r\n                        <input id=\"rform-select-204862420\"\r\n                            class=\"rform-select rform-input\" type=\"text\"\r\n                            placeholder=\"Please Choose Option Here\"\r\n                            readonly required>\r\n                        <input class=\"rform-select-input\" type=\"text\" name=\"Receive Type\" value=\"\" hidden>\r\n                    <\/div>\r\n                    <div class=\"rform-options-container\">\r\n                        <ul>\r\n                                                            <li class=\"rform-option\" data-value=\"Pick Up\" >Pick Up<\/li>\r\n                                                            <li class=\"rform-option\" data-value=\"Delivery\" >Delivery<\/li>\r\n                                                    <\/ul>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-select-err-204862420\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cd94e22 elementor-widget__width-inherit elementor-widget elementor-widget-text\" data-id=\"cd94e22\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control \">\r\n                                <input name=\"Delivery Address\" placeholder=\"Enter your address (only if Delivery is selected)\" class=\"rform-input\" id=\"rform-input-text-215567906\" type=\"text\" onblur=\"validate_input( 'rform-input-text-' , 'rform-input-err-' ,'215567906')\" aria-invalid=false data-val=\"by_char\"   >\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-215567906\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span>This field is only needed if you chose Delivery as your option.<\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-acd08f6 e-con-full e-flex e-con e-child\" data-id=\"acd08f6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f87f849 elementor-widget elementor-widget-heading\" data-id=\"f87f849\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Extra Note<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-249478f9 elementor-widget elementor-widget-text-area\" data-id=\"249478f9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-area.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-container\">\r\n            <div class=\"rform-control \">\r\n                                <textarea name=\"Extra Note\" placeholder=\"Message Here\" class=\"rform-input\" id=\"rform-input-textarea-613710073\" type=\"text\" onblur=\"validate_input( 'rform-input-textarea-' , 'rform-input-err-' ,'613710073')\" aria-invalid=false data-val=\"by_char\"   ><\/textarea>\r\n            <\/div>\r\n            <span role=\"alert\" class=\"rform-error\" id=\"rform-input-err-613710073\">This field is required<\/span>\r\n            <div class=\"rform-help-text\">\r\n                <span><\/span>\r\n            <\/div>\r\n        <\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-42c7e680 elementor-widget elementor-widget-rform_button_submit\" data-id=\"42c7e680\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"rform_button_submit.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t        <div class=\"rform-button-container\">\r\n            <button class=\"rform-button-submit rform-btn-fullwidth\" type=\"button\" id=\"rform-button-submit\">\r\n                <div class=\"rform-btn-icon-container\">\r\n                                    <\/div>\r\n                Submit Now            <\/button>\r\n        <\/div>\r\n\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t            <\/form>\r\n            \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Refill Prescription Form Focused on What Matters: Your Health Get Your Medications On Time Easily request a refill for your medications using the form below. Just fill in your information, select your delivery method, and we\u2019ll take care of the rest. Your health and convenience are our priority. Required Login Please Login for Submit Form. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-139","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Refill Request - Pine Island Pharmacy<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pineislandrx.com\/es\/refill-request\/\" \/>\n<meta property=\"og:locale\" content=\"es_MX\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Refill Request - Pine Island Pharmacy\" \/>\n<meta property=\"og:description\" content=\"Refill Prescription Form Focused on What Matters: Your Health Get Your Medications On Time Easily request a refill for your medications using the form below. Just fill in your information, select your delivery method, and we\u2019ll take care of the rest. Your health and convenience are our priority. Required Login Please Login for Submit Form. 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