Medication Refill Request

• Confirm you are eligible: You must be a current PCS medication-management client with an urgent refill need that cannot wait for your next visit.

• Call your pharmacy first: Confirm whether a refill is already on file before you submit anything to us.

• Complete the form below: Include your date of birth, the medication name with its specific dosage, and the reason for your request.

• Wait for our response: Please do not call the office to check the status of your request — see “What Happens Next” below the form.

• Running out early: You will run out of medication shortly before a scheduled follow-up visit.

• Unexpected emergency: An unexpected emergency prevents you from attending your scheduled appointment.

• No scheduled visit: You do not have a follow-up visit scheduled with a PCS prescriber.

• Not seen recently: You have not been seen by a PCS prescriber within the past 90 days (or within the required timeframe for controlled substances).

• Frequent cancellations: You frequently cancel or miss scheduled appointments.

• Outstanding balance: You have an outstanding balance on your PCS account.

If you need to schedule an appointment, please call 385-246-1046.

• Call your pharmacy: Please contact your pharmacy to confirm whether you have any refills remaining. Pharmacies often have active prescriptions on file even when clients believe they are out.

• Ask about your prescription number: Each new prescription is assigned a new prescription number — your pharmacy can confirm whether one is still active.