Please fill out the request form below for a prescription refill. Our goal is to respond within 48 hours.  As a reminder, your request for a prescription refill is a convenience we provide for Page, Hudson and Taylor purposes only. Many requests will require an appointment and unfortunately no new prescriptions can be prescribed online. If you need a controlled substance or pain medication please call our office to make an appointment.  Prescription refill requests can only be used for refills of routine maintenance medications without any changes from a current prescription. If you need to change your current prescription or need a new prescription please call our office at 205.939.2806. In an effort to provide exceptional care, we can only refill your prescription request if you are up to date on your yearly exam. If you have a medical Emergency, please call 911.

Name *
Name
Date of Birth *
Date of Birth
Cell Phone *
Cell Phone
Home/Work Phone
Home/Work Phone
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Pharmacy Phone Number *
Pharmacy Phone Number