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Prescription Refill Request
This section allows you to request a prescription refill online. If you believe that you have an emergency, immediately call 818-784-8481 for an appointment, or, if truly warranted, dial 911.

Please be aware that one of the purposes of an appointment is to ensure you have enough medications until your next scheduled visit. Anticipate any refill needs and discuss during the office visit. Calling in a refill is considered a courtesy needed when unexpectedly appointments are changed or due to recommended medication adjustments. In order to continue to prescribe a medication, the doctor needs to see you in person to review progress, side effects, update labs and potentially make additional adjustments. Bear in mind that this is for your safety.

Often, it is not advised that a patient abruptly discontinue medications, so an occasional request to refill a medication will be authorized when appropriate. Requests for refills may take up to 72 hours and are not done on weekends or holidays unless an emergency, so patients should plan accordingly. Patients not seen for over 4 months will need to be seen before medications can be refilled. Frequent requests for refills without being seen in the office may result in a $50 charge or discontinuation of services.

Please complete the following form and an office representative will follow up with you regarding your request. Please note that:
  • A secretary will contact you within one working day regarding your request, between 8:30 am and 4:30 pm.
  • Depending upon the time of your online request, the secretary might contact you on the next business day.
  • You are hereby advised that information transmitted online via this form cannot be guaranteed to be secure. Online communications are subject to interception by third parties who may be under no obligation to keep such communication confidential. Thus, do not transmit sensitive or confidential information via this form. You may, alternatively, contact us at 818-784-8481 to inquire about your prescription refill request.

Prescription Refill Request Form
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