PRESCRIPTION REFILL REQUESTS
This prescription refill request is for the convenience of our current clients only. It is our office’s policy that medication refills will only be provided at regularly scheduled psychiatric follow up visits. This form is intended for urgent medication refill requests only, such as situations in which a client will run out of medication shortly before a scheduled office visit or situations in which an emergency prevents a client from attending a scheduled office visit.
MEDICATION REFILLS WILL NOT BE AUTHORIZED IN THE FOLLOWING SITUATIONS:
- You do not currently have a psychiatric follow-up visit scheduled with one of our psychiatric providers.
- You have not been seen by one of our psychiatric providers for an extended period of time.
- You often cancel or miss scheduled appointments at our practice.
- You have an outstanding balance for services received at our practice.
- You are requesting a controlled substance.
PLEASE READ BEFORE SUBMITTING YOUR REQUEST:
- Please contact your pharmacy to make sure that you do not have any refills remaining on the last prescription(s) provided by our office.
- The length of time needed to respond to your request will depend on factors such as the office hours of your psychiatric provider and the day of the week you submit your request. We will respond to your request as quickly as possible, but please be aware that it typically takes 3 business days before you receive a reply.
CLICK BELOW ON YOUR PSYCHIATRIC PROVIDER TO SUBMIT YOUR REQUEST.
Dr. Elisa Warren, DNP, APRN, PMHNP-BC
Dr. Manny Slack, DNP, APRN, PMHNP-BC
Dr. Megan Kimberly, DNP,FNP,CNM,PMHNP-BC
Utah's Leader in Mental Health Treatment: Helping You Overcome Life's Challenges
MIDVALE:
613 E. Ft Union Blvd #104
Midvale, UT 84047
WEST JORDAN:
8153 South 4800 West
West Jordan, UT 84088
AMERICAN FORK:
150 South 400 East
American Fork, UT 84003