RX REQUESTS WILL BE PROCESSED WITHIN 48 HOURS.

Patient Information
REFILL REQUESTS
MEDICAL PROVIER

Thank you for submitting!

Your request will be processed within 24 hours.

PLEASE NOTE
If your medication is not on the list below, DO NOT use this refill request.
Instead, please call your pharmacy, and have them fax us a request at fax (913) 890-7285.

If you are using a pharmacy for the first time for your prescriptions, please enter the new pharmacy information.  Your prescription will be called in by your provider to the new pharmacy.  After this, refills can be faxed to our office from that pharmacy.