We will not refill medications outside of our office hours.
Please provide us with at least 48 hours notice for when you need a refill.
Most pharmacies will provide a three-day emergency supply of a medicine
without a doctor's approval if you forget to have it refilled prior to a weekend.

Prescription drugs must be regulated carefully. If you have not been seen for a while, you may be required to come in for an evaluation. This ensures the safe use of sometimes dangerous medications.

Controlled Substances
These are drugs closely monitored due to their potentially addictive nature.
Be aware that they often require monthly visits to obtain hard copies of the prescription.


Please use the form below to e-mail your medication request to us.
We will reply via e-mail within 2 business days.
NOTE: Fields with * are required fields.
 
* Patient Name:
  (First and Last Name)
 
* Phone #:
  (include Area Code)
 
* E-mail Address:
 
       
 
Is this a Refill?
 
 
* Drug Name:
 
 
Strength/Dose:
  (e.g. 10 MG)
 
Directions:
  (e.g. One a Day)
 
Quantity:
  (e.g. 30 or 30-Day Supply)
 
Number of Refills:
 
 
Prescribing Doctor:
 
       
 
Pharmacy Name:
 
 
Pharmacy Phone #:
  (include Area Code)
 
Request to:
 
   
 
Comments: