Prescription Refill Request Form

Dr. Stokan is now set up through the DEA to eScribe medications.  This means patients no longer need to come in to the office to pick up written prescriptions.  We still need to receive your requests the same way through our website.We just ask for you to reply and provide us with your pharmacy. Please call your pharmacy for any refill medications.

**Please Note**

 A denial of your request is possible if you have not had regular follow up sessions with Dr. Stokan.”

Patient Information

  • Pharmacy Information

 

Medication

    Prescription 1

  • Prescription 2

  • Prescription 3

 

Comments and Submittal

 

Verification