CLOSED: Thanksgiving
OPEN:  11/29 Fri 8-11am Walk in clinic only - 146th St Office
OPEN:  11/30 Sat 8:30-10am  Indianapolis - Clearvista Parkway Office
OPEN:  12/1  Sun 4:30-6pm  Noblesville - 146th St Office
FLU UPDATE here!
New Payment Option - CareCredit 

Prescription Refill Request Form

Patient Information



Give first and last names



Use the format MM/DD/YYYY



Give first and last names



For directions to each of our locations, please see our Location pages.


Contact Information



Use the format 317-555-1212



Use the format 317-555-1212



Yes No

Prescription Details






Limit: 1,500 Characters


Call in to Pharmacy
Pick up in Person
Mail to my House

Call to Pharmacy

Call this prescription in to my pharmacy





(Use the format 317-555-1212)

Note: Some medications, including stimulants used to treat ADHD, can not be called in to a pharmacy.

Pick up in Person

I will pick my prescription up from :

Mail to Home

Mail this prescription to my home address:






Note: This address will be compared with address on file for the patient.




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.