Request for Refill, Form, or Letter

If you need a refill before your next scheduled appointment, or if you need a letter written or a form filled out before then, please submit the information as a message in the patient portal. There is a $20 fee to cover the time spent providing this service if it occurs outside of an appointment. After we receive the request, we'll issue a bill for this, which you can pay within the portal.

For refills, please include the medication name and dosage. If you would like it sent to a pharmacy other than the one that is on file, please specify the name, address (including zip code), and phone number of the pharmacy.

For forms, please include the form as an attachment to the message, and specify by when it should be completed.

For letters, please specify what type of letter you need written, what information it should contain, and by when it should be completed. If applicable, please include whether you do or do not want your diagnoses or medications included.