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Available Forms

6. Prescription Refill Request

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.

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