Prescription Refill Authorization

Step 1: check your prescription

Check your prescription label to see how many refills you have left. If you still have authorized refills, simply contact your pharmacy to refill it. No need to contact me.

For Empower Pharmacy, you can fill out this form to request a refill. It takes 1-2 business days to process the refill and up to 5 days to receive it, so please plan ahead. Ground shipping is $10. 2nd Day is $20. Overnight is $25 (if Saturday Overnight, it is $45).

Step 2: Fill out prescription authorization request

If you have 0 refills on your prescription, then I will need to authorize a refill. Please fill out the form below. For mail order prescriptions, fill out 7-10 days in advance. For local pharmacies, fill out 4 days in advance.