This Form Can Be Used To:
- Request medication refills
- Submit medication-related inquiries
- Request a follow-up appointment
Requests Not Accepted on This Form
- New medication requests
- Please schedule a follow-up appointment to discuss these requests
- Please schedule a follow-up appointment to discuss these requests
- Medication changes that have not been previously discussed with your provider
- Please schedule a follow-up appointment to discuss these requests
Processing Time & Requests
- Prescription refill requests are generally reviewed each business day at approximately 10:00 AM, Monday through Friday. Requests submitted before 10:00 AM may be reviewed that day, but same-day completion cannot be guaranteed.
- Please allow up to 72 business hours for our team and the pharmacy to complete your request. To avoid running out of medication, we recommend submitting this form at least one week before the refill is needed.
- After submitting this form, please do not call or send a portal message, as duplicate requests delay processing.
Please enter the client’s name. If the client is a minor, include their full name along with the parent’s email address on file. If you are the client and an adult, enter your own name and email address.