Refill Request Form


Can any patient use this form?
  • The Refill Request form is for existing patients who have seen a provider within the last three months & have an upcoming (scheduled) follow-up appointment. All requests from those who do not meet these requirements will be denied. 
How long will it take to process my refill request?
  • Refill Request processing can take up to 48 hours. Requests are processed Monday-Friday, 9:00am-4:00pm. Requests submitted after 3:00pm on Friday, Saturdays, Sundays, or holidays will be processed the following business day. Please plan accordingly.
Can I use this form for all medications?
  • Medications for ADD/ADHD including Adderall, Vyvanse, Ritalin, & others, CANNOT be called-in or faxed to your pharmacy; these must be picked up from your provider's office.