BIRTH CONTROL REFILL REQUEST
Hill County Family Planning 302 4th Ave. Havre, MT PH: 406-400-2416 Fx: 406-265-6976
Name:
*
First Name
Last Name
Date of Birth:
*
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Month
-
Day
Year
Phone Number
*
Please enter a valid working phone number.
Comments, question and/or concerns:
Expect at least 24 hours for refill to be ready.
This DOES NOT include holidays and weekends that we are closed. Anything received after 4pm will be processed the next day.
Submit
Should be Empty: