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Medication Refill Request

Please complete this form to request a medication refill.

Please allow at least 24 hours to process each request. Any information that is not included will delay the processing time.

All children need physicals once a year and a med check every six months. If your child has not had a physical within the past year, we cannot refill prescriptions. Also know that some medicines, including antibiotics, cannot be refilled without a physician first examining your child.

ADHD medicines cannot be called in. The pharmacy must be presented with a new written prescription each month. Always allow time when requesting refills so that the child does not run out of medicines. ADHD prescriptions must be picked up at the front desk or mailed home.

*If you would like us to mail the prescription home, please send in self-addressed stamped envelopes prior to requesting refills.

Prefer to print and bring in to our office? Download the form below.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
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