OPEN 5 DAYS A WEEK. WALK IN OR CALL Request Prescription Refill Online American Urgent Care & Infusion Centers helps you save time and money. Fill out the form below to submit your prescription refill request. Phone First name * Email Address * Last name * Contact Cell Number Patient's First Name Patient's 5 Digit Zip Code Patient's Last Name Last 4 Digits of SSN Patient's Date of Birth Which Clinic Is It Related To 6125 S Eastern Ave. 4161 S Eastern Ave. Maryland Pkwy Jeffery's Henderson Rainbow Blvd Not Applicable Message Subject Enter Your Message * Web Site Contact Us First name * Last name * Email Address * Phone Message