Tranquility Behavioral Health Patient Portal

Tranquility BHC MEDICATION REFILL REQUEST

First & Last Name * D.O.B. * PROVIDER * How Many Medications Needed * Name of Medication / Reason for Request * Date of Last Appointment * Do you have an upcoming appointment *

If so, please input the date.

UPCOMING Appointment Date

Controlled substance refills may be subject to fee for qualifying patients. All patients on controlled substances are required to be seen every 30 days in order to receive a refill. Please make sure that you have an upcoming appointment. We will not refill any controlled substances without an appointment. If you have questions regarding your refill, please contact the office at: (832)879-2107.

Have you made an appointment to receive your controlled substance refill? * Phone Number * Email Address TODAY'S DATE *

All medication refills request will be reviewed at the end of the business day of which you submitted.

Any request submitted after 4:30 p.m. will be reviewed at the end of the following business day.

Calls or Faxes from pharmacies will not be honored and is not an acceptable form of requesting a refill.

Please allow up to 48-hours to inquire about a recently submitted request.

If you have not received an update within 48-hours of the day you originally submitted your request, please contact the office via phone at: (832)879-2107.

Are you requesting a Pharmacy Change? *