This 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 while you are in the office.
Repeated refill requests for the same medication will not be authorized, please only submit form once per request. 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. We do not fax prescriptions to pharmacies.
Please fill in the form clearly with the exact name of the medication, dose, and directions in addition to your pharmacy information. It may take up to 72 hours (or longer) to send in your script, especially during holidays or weekends. Call your pharmacy to check if they have received the script. You should have at least a week of medication left when you request a refill to insure you do not run out of medication.
Please Read The Following
Check with your pharmacy if you have any refills left on your last prescription before sending in this request. Use for medication refill requests only. Do not use this for any other purpose.
It can take 1-4 days to respond to your request, longer if requested on Fridays or during holidays. Check with your pharmacy about the status of your prescription in 24-72 hours. Our office will contact you if your medications can not be called in for any reason.