We use this form to collect information to help us process your refill request quickly and convieniently. Please note this form is for refills only. If you are experiencing a medicaiton concern or are wanting to to make changes to your medicaiton please contact our office by phone.
This form is HIPPA compliant; any information entered into this form is stored and saved securely and will be used for the purpose of evaluating your medication request.
Please note that a $15.00 medication refill fee for evaluation and management of prescriptions via telephone, text, portal, or email due to missed, cancelled, or unscheduled follow up appointments may be billed to your patinet account. This fee is not covered by insurance.
This form inbox is monitered deligently during our business hours (Monday-Thursday 8:00am-4:00pm and Friday from 8:00am-12:00pm; excluding holidays). If your request is made outside our normal buisness hours it will be addressed on the following buisness day. If your request is urgent please call our office number 334-954-6010 and leave a voicemail with detailed information regarding your request.
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