Medication REFILL request

• Please complete ALL information in order for your medication to be sent in a timely manner. You can request more than one medication at a time.

• DO NOT CALL OR SEND A MESSAGE THROUGH THE PORTAL AFTER COMPLETION OF THIS FORM! 

The purpose of this is to reduce call and message volume and improve timeliness of refills. 

When this form is submitted, your provider will send for the prescription by the end of the same day if submitted on a business day M-F by 430pm

If this is an ADHD medication such as Adderall (amphetamine salts), Vyvanse (lisdexamfetamine), Ritalin/Concerta (methylphenidate) etc…These medications can only be filled every 28 days. But you can submit this form early so then your prescription will be ready before you run out. Please plan ahead, prescriptions will not be sent on weekends or holidays.