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Prescription Form

If you would like to have prescriptions transferred to the pharmacy on campus at Student Health Services, please fill in the spaces below. Because of the high volume of transfers requested at the beginning of the school year, please turn in any requests at least one week before needing the medication, if possible. Please present a copy of your prescription insurance card to the pharmacy prior to filling any prescriptions. Call Quadrangle Pharmacy at 314-935-6662 if you have any questions.
New York Residents: New York state law limits the ability to transfer prescription refills. Please have your provider call or fax us new prescriptions or write them for you to bring to the pharmacy instead of requesting a transfer.