This form is intended to receive refill requests from active patients. Please allow us 36 hours to send in your prescription, and if it is requested on the weekend please allow an additional 48 hours.
This form is intended for routine medications, not emergent situations. If there is an emergency requiring immediate medication assistance, please call 911 or seek further care from the closest urgent care or emergency department.
A follow up is necessary for EpiPen refills. If you submit a request for an EpiPen for either food allergy or stinging insect allergy, please call us to set up a follow up appointment. If you do not schedule a follow up, we will not refill your EpiPen until we have evaluated the reasons behind the refill request. There will be no exceptions to this rule.
By entering your information below, you are agreeing to the terms above.
