Refill Request Form
Please note: The fastest way to request a medication refill is always through your pharmacy as they will send your complete medication information directly to your healthcare provider.
If you have already attempted a refill request through your pharmacy but have not received any response from them, please complete the following request.
Please include area code
Please read carefully
Please note: Controlled medications require monthly visits.
Most medications managing chronic diseases (ie. Diabetes, High Blood Pressure, High Cholesterol) require visits every 3 months and bloodwork and to monitor efficacy and check liver/kidney function.
Maintenance medications (ie. controlled asthma) typically require a visit every 6 months.
If your medication request exceeds its requirements, please call our office at 904-276-1133 to schedule your follow-up appointment.
Please list what medications you are requesting to be refilled.
We check medication requests every hour during normal business hours. Requests are then sent to your healthcare provider for approval. A staff member will contact you within 24-48 hours.