Prescription Refill Request Form

Please complete the following prescription refill request form - all fields must be completed before your prescription request can be processed.  If you are unsure of any of the information required, please call your pharmacy and have them fax a request to 692-2446. Requests will be authorized within 24 business hours as long as you are up to date with your annual gyn exams.

We do not refill prescriptions on the weekends or after office hours. In addition, pain medication cannot be refilled electronically. If this is a new prescription, you may need to be seen in our office before we can call it in. If the triage nurse has any questions she will contact you by phone.

Please Complete Form: (all fields are required)

Over The Counter Medication

Download/print our list of OTC meds that are safe to take in pregnancy.