Medication Refill Request

Complete the form below to request a refill in your medication. Please allow up to 48 business hours for your refill to be sent to your pharmacy.

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Thank you for your med refill request. Please allow up to 48 business hours for your request to be processed.
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In submitting the information above, I am aware that I may be sending private and confidential information through a means that does not meet the requirements of the HIPAA Privacy and Security Rules. I also understand this and any communication prior to an initial session does not constitute a patient-provider relationship. If you selected texting, by submitting your information, you consent to receive SMS communications from us. Reply STOP to any message received to unsubscribe or HELP for assistance.

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