Refill Requests

Simplify your medication refill process. Existing patients can request refills by providing the following information:

Patients Name(Required)

First Last

Patient's Date of Birth

Medication Name

Controlled Substance

Yes

30 or 90 day refills

30 day refills

90 day refills

Prescribing Doctor's Name

First Last

Pharmacy Name:

Pharmacy address medication is to be sent to:

Street Address City State ZIP Code

Comments

This field is for validation purposes and should be left unchanged.

For Refill or Pharmacy requests/inquires also feel free to CALL our patient advocates at (202) 918-7512 or EMAIL at jguzman@washinterpsych.com.