I agree that the prescriptions I am submitting are only for the individual to whom they are prescribed. Upper Levisa Clinic Pharmacy reserves the right to validate any or all of my prescription refills due to the lack of personal validation and has the right to deny my prescription refills requests, until further validation is provided. Please fill in the form below and follow the directions provided. Your refill request will be sent securely to Upper Levisa Clinic Pharmacy. We will process the order and keep it at the pharmacy counter, and ready for pick up.