CQI Partner PCAB Accredited

Refill Online

Refill your prescription quickly and easily by email! Simply fill out the form below.

After successfully completing the form, you should see a green confirmation message at the bottom of this page. If you do not see this message, your refill request may not have gone through. Please send an message to Our Office Email (Click Here) with the subject “REFILL” along with all information, or call the patient care services team at (800) 836-2303.

Thank you.

Patient Name: (required)

Prescription #s: (required)

Refill For: (required)

Daytime Phone: (required)

Your Email (required)

Notes or Special Instructions:

Delivery Methods: (required)

Note: Shipping charges will automatically be charged to your account based upon shipping method selected. If no method is selected, prescription will be sent via US Mail.

Other delivery options available, prices vary, please contact us for more information (248-489-1573).

The privacy of your health information is important to us. We will never share your information with unauthorized third parties. To review/print our patient privacy policy, click here