Go Back Prescription Pick-Up Request Email * Unit Number * Last Name on Lease * Desired Pharmacy: * CVS, 511 N Hollywood Way Pavilions, 1110 W Alameda Ave AMC Pharmacy, 2625 W Alameda Burbank Compounding Pharmacy Walgreens Pharmacy, 2501 W Magnolia Blvd Name of Patient: * Date of Birth of Patient: * MM DD YYYY Comments Permission to enter? * Due to the nature of this request we can not leave prescriptions outside of units and REQUIRE permission to enter. NO - Please cancel this request YES - Please leave the prescription inside my apartment Checkbox * I agree to reimburse Talaria Burbank for the prescription requested above. I consent to have the charges incurred posted to my resident ledger. Thank you! Your request has been submitted.
