Request Medication Refill Home » Patient Center » Request Medication Refill Name(Required) First Last Date of Birth Month Day Year Email(Required) Phone(Required)Medication Name(Required)Medication Dosage(Required)CommentPLEASE NOTE: *Medication refills may take between 24 and 72 hours to complete. **Medication refills may require an appointment. If an appointment is needed, a staff member will reach out to help you schedule one.PhoneThis field is for validation purposes and should be left unchanged. Schedule Appointment Find A Heath Center Become A New Patient Access Patient Portal