Prescription Refills

Family Medicine Associates processes almost all prescriptions and refills through the Surescripts network. We send prescriptions to your pharmacy through this secure, efficient electronic portal. When the pharmacy receives the prescription, they send a confirmation back to FMA via e-mail. The pharmacy then fills the prescription so it will be ready for you to pick up.

At Family Medicine Associates there are three ways to request refills of your prescriptions.

1. Call your pharmacy. The pharmacy will contact your provider via the secure Surescripts network and request authorization. Your provider will authorize the refill via return e-mail, and the pharmacy will fill the prescription.
2. Call FMA and leave a message for your provider requesting a prescription refill.
3. Complete and submit the form below.

When requesting a refill, please allow 24 business hours for FMA authorization.

FMA authorizes prescription refills only during regular office hours – not after hours or on weekends or holidays.

Date: (MM-DD-YYYY)
Patient Email:
Physician:
Patient First Name:
Patient Last Name:
Patient date of birth:
Patient phone number:
Pharmacy:
Pharmacy Phone:
Pharmacy Address:
Pharmacy Fax: if known
Medication Name:
Medication Dose:
Directions:
Number to be given:
Number of refills: