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Prescription Refill Request Form

Patient Information
Contact Information
Give first and last names
Use the format 317-555-1212
Use the format MM/DD/YYYY
Use the format 317-555-1212
Give first and last names
Prescription Details

Notes About this Form

Prescription Refills
Prescription refills [other than ADHD meds and other controlled substances] requested prior to 1:30 pm will be processed by the end of the business day. Refill requests received after 1:30 pm will be processed by the end of the next business day and sent electronically to your pharmacy. (Pharmacy information that is listed in your child’s chart) Yearly checkups and follow up appointments by a Northpoint provider are required to continue to refill medications.

 ADHD Medication Refills
Controlled medications such as ADD meds (Adderall, Vyvanse, Methylphenidate, Ritalin, etc.) must be refilled monthly. ADD/ADHD medications can soon be sent electronically to the pharmacy. (Pharmacy information that is listed in your child’s chart) The processing time for your refill may take up to 7 days due to chart review by the primary physician. Required yearly checkups and “medication follow up appointments” directed by your primary provider must be current in order to refill ADD/ADHD medications.