Refill Request Form

Please read the following information before submitting your request:

Please allow 72 hours for us to complete all refill request(s). 

Medications are prescribed to last until your next follow-up.

Check your pharmacy first for refills. If you do not have refills remaining, please use this refill request form.

Refill requests submitted by pharmacies are not processed by our office.

Any refill requests received after 10am Fridays may not be processed until the following Monday.

Stimulants: Supply may be limited to 1–3 months. Reviewed and signed by Dr. William Privitera, MD.

Refills are not processed on weekends or holidays.

Lost or stolen prescriptions cannot be replaced.