Medication Refill Request

** Please note: If you have not received your prescriptions please resubmit your request here a second time to ensure your request is handled in the most timely manner. (Many requests can be sent within hours but refills may take up to 3 business days) We will send a confirmation text if requested below once we have processed your request.

I understand that the Medication Refill Request I completed here will be reviewed and if approved will be sent to the pharmacy listed here within the next 3 business days and that I can call (817) 545-9100 option #4 with any questions or concerns. *

I understand and agree.

I understand that there is a national STIMULANT (Adderall, Ritalin, Vyvanse ect.) shortage and that John Naus MD PA may issue medication prescriptions but that my provider or any other associate of John Naus MD PA cannot be held responsible for for the availability of any medication at any pharmacy. *

I accept this policy and I understand that moving my medication may lessen my chance of getting my medication filled.

Patient Name *

First

Last

Date of Birth *

NUMBER OF REQUESTS

How many medication refill requests have you submitted in the last 7 days? *

MEDICATIONA REQUESTED

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