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Prescription Refills

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

Stimulant medications for ADHD cannot be phoned in per Federal Law.

Prescriptions for stimulants must be picked up personally at our office or can be mailed to you if you provide us with self-addressed stamped envelopes.

  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 #)
  Pharmacy Information:

           Pharmacy Name:

 * required

           Pharmacy Phone:

 * required

    Other Information: