Please fill in the form below clearly and completely and include all requested information. Omitting required information will cause a delay in our response to your request.  Please DO NOT call the office to check the status, we will respond as quickly as possible.

Full Client Name:

Client Email:

Client Date of Birth:

Name of Medication & Specific Dosage:

Pharmacy Name:

Pharmacy Phone:

When is Your Next Follow-Up Appointment? (Please note, refills may not be approved without a future appointment- call (801) 984-1717 to schedule.)

Notes for Reagan Lenington:

User Agreement

By continuing, I agree to have read and understand the following information:

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. It 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 may 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 and have not seen your provider within the last 90 days.
- You are requesting an Adderall prescription and are over the age of 18. Learn More Here

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 upon factors such as the office hours of your psychiatric provider and the day of the week you submit your request (we do not respond to requests on weekends or holidays). We will respond to your request as quickly as possible, but please be aware that typically it takes 3 business days before you receive a reply.

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