Refill Request

Please request prescription refills during office hours and allow us 24 hours for your request to be completed. Some prescriptions must be written such as Ritalin, Adderall, Clonidine, and Concerta, Metadate CD, and are not allowed by law to be called into a pharmacy. They must be provided to the pharmacy in a printed form.

Please note, we do not refill medications after office hours (call before 4:00 PM during office hours).

Important Information:

If you have an issue that is confidential, please contact our office at 678-688-1580. Please know that our staff as well as the MDs may be reviewing your request. This feature is for non-emergency, non-urgent request -- the requests are reviewed once daily. If you have not received confirmation of your request by email within 2 working days, please contact the office by phone. To request an on-line refill, please fill out and submit the form below:

Refill Request Form:

Patient's Name:

Patient's D.O.B.

Sex:

Primary MD:

Your Email Address:

Daytime Telephone (including area code):

Medications Requested for Refill

Medication Name:

Dosage:

Check here if you wish to pick up your prescription from our office:

If you wish us to call in the prescription to your pharmacy, please enter your pharmacy name and telephone number.

Pharmacy Name:

Pharmacy Telephone:

Comments: