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Prescription Refill Request Form

Medication Refills other than Controlled Meds that are requested before 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 the pharmacy listed in your child's chart. Schedule and attend the required yearly checkups with a Northpoint provider. This is essential for monitoring the effectiveness of the medication and ensuring your child's overall well-being. Failure to make and keep recommended visits will result in no refills prescribed until the patient is seen in the office.

ADHD and any other Controlled Medication Refills

  1. Allow for Processing Time.
    Recognize that there will be some processing time involved due to the chart review conducted by the primary physician. Plan ahead to ensure that you have an adequate supply of medication. Due to the shortage of ADD medications, we can only submit refills for 30 days at a time.  This means you will need to request a refill for each 30-day supply of medication.

  2. Find a pharmacy that has your medication in stock.
    Before submitting a refill request - FIRST call and verify your pharmacy has the medication in stock.  If it does not, please locate a pharmacy that does have it - and THEN submit your refill request with the pharmacy name, address, and phone where the medication refill needs to be sent.

  3. Schedule Yearly Checkups and Medication Follow-up Appointments. 
    Schedule and attend the required yearly checkups with a Northpoint provider. This is essential for monitoring the effectiveness of the medication and ensuring your child's overall well-being. Failure to make and keep recommended visits will result in no refills prescribed until the patient is seen in the office.

  4. Attend Medication Follow-Up Appointments.
    Keep up with any additional appointments related to medication management as directed by the primary provider. These appointments are essential for evaluating the dosage and effectiveness of the medication.

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