Medication Refill Request Form for Ukiah & Lakeport Offices

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1.  Complete the "Medication Refill Request" . Please let the practitioner know if you have any medical changes or questions to be answered. 

2. A staff member will pull your chart for the medical provider to review. 

3. Some clients will need a phone interview or will need to be seen in person by the medical provider. (Office staff will call you to make arrangements if needed.) 

4. Upon approval your medications will be mailed to you OR arrangements will be made for medication pick up.