(770)436-9700














(770)436-9700
 

  
 


Refill a prescription
Subject to your doctor's approval, your existing prescription can be refilled by providing us the information below.  The exception to this process is those prescriptions that must be presented in writing because of government safety requirements.  Confirmation that we have called your prescription in will be sent to your email address or you will be notified by phone.

Please note - prescription refills are not automatically granted.  A refill authorization is generated at the sole discretion of your physician.  Our physicians all have very busy schedules and at times it can take up to 2 business days for them to review your request.  Please make sure you consider this fact when you submit your request or prior to contacting the office for information regarding the status of your request.

Because of the professional time involved in processing prescription refills outside of your normal appointment we collect a $40 fee prior to beginning the refill process.  Please click below to pay that fee online. A separate, secure page will open to process your payment.  After finishing that transaction please return to this page to provide the information needed by this office to process your refill.

Please click the button below to open up a fresh window that will allow you to pay this fee prior to filling out the required information below.

  
     
 


  NOTE:  Information that is required is denoted by a red * next to the box.

  Name:
  *Required

  Patient Name:
 

  Email:
 

  Phone:
  *Required

  Date of Birth:                    *Required

  CPG Physician:                   *Required

 

  Pharmacy Name:        *Required

  Pharmacy Phone #:   *Required

  Pharmacy Fax #:       




  Prescription #1
  Prescription Number: 

  Medication:                 *

  Dosage:                     

  Date of last refill:      
 

  Prescription #2
  Prescription Number: 

  Medication:                 *

  Dosage:                     

  Date of last refill:      

  Prescription #3
  Prescription Number: 

  Medication:                 *

  Dosage:                     

  Date of last refill:      

  Prescription #4
  Prescription Number: 

  Medication:                 *

  Dosage:                     

  Date of last refill: