Dear [Doctor’s Name],

I am writing to request a prescription for [medication name]. My last refill was on [date of last refill] and I am running low on my supply.

I have attached a copy of my insurance card and any necessary forms for your review. Please let me know if you have any further questions or need additional information.

Thank you for your prompt attention to this matter.

Sincerely,

[Your Name]

Note: It is important to include any relevant information, such as your insurance card and any necessary forms, when requesting a prescription. 

You may also want to include any relevant medical history or information about any allergies or conditions that could affect your treatment. 

If you have any specific concerns or questions about the medication, you can include those in your letter as well.

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