Medication Refill Request

Existing patients can save time by filling out our online medication request form below. Online medication refill requests require a minimum of two (2) business hours for doctor approval and processing. Generally, emails are checked at 8:30am, noon and 5:30pm on business days. If refills are needed sooner please call our office at (702) 243-1885. Please fill out a separate request for each medication.

First Name
Last Name
Patient Name
Medication
Quantity or Time Frame (i.e. one month of medication)
How are you currently administering this medication?
Pick up or mail this medication?
Email / Phone
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