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Finnegan Health Services
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FHS Refill Request
Eclipse Medical / Finnegan Health Services
Medical Supply Refill Request
Submit your refill request directly to the Eclipse team.
Refill Request
Do you require a supply refill?
Yes, I need to place an order for all supplies that have an active prescription on file.
Yes, I need the same supplies as the last order dispensed by Finnegan Health Services.
Yes, but I need to change something about my order or I need assistance.
No, I have plenty
Other
If you need to change something about your order, please describe the change...
Who are you ordering for?
Patient's Name
Patients Date of Birth
Confirm Your Contact Info
Has the doctor changed?
Yes
No
Are there any insurance changes?
Yes
No
By typing your name below, you confirm that you are requesting supplies and authorize FHS to process this refill request.
I confirm the information provided is accurate.
Submit Refill Request