Medication Refill Request form is for the convenience of our current patients. This helps minimize phone calls and allows our office staff to attend to your needs quickly and efficiently.
Please note, if you do not wish to submit protected health infromation you should call the office and address your request with a staff member. This form is intended to address your refill request quickly and calling into the office can increase turn around time to address.
Repeated medication refill requests will not be authorized. Additionally, patients who have not been seen in the office for a long time or who frequently miss their appointments may not be provided with refills.
Fill in the form completely including the accurate pharmacy infromation. It may take up to 72 hours to complete a refill request or longer if during weekends and holidays. Please do not call the office to check on the status of your request.
Please call your pharmacy to see if they've received your presrciption. You should have more than 3 days of medication left at home when you request a refill.