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Prescription Refills

PRESCRIPTION REFILLS 
 
Medication refill requests left via e-mail will be electronically sent to pharmacy within 1 business day of your request.

ALL prescriptions can now be electronically sent to the pharmacy, including stimulant ADHD medication.

Please contact your pharmacy after 24 hours of the request to confirm if they have received the prescription(s).

 

  Rx information:

First name:

 Last name:
 * required
 * required
DOB:
 * required
       Clinician Name:
 * required
Rx Name & Dose:
 * required

Rx Name & Dose:

Rx Name & Dose:
Requested by: (Name & phone #
Provide email if you would like to be emailed when prescription is ready)
  Pharmacy Information:

Pharmacy Name:

 * required

Pharmacy Phone:

 * required

    Other Information: