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.

We think this service will make most of you very happy!!

This refill request is intended for C2 prescriptions ( Adderall, Ritalin, Concerta, Focalin, Vyvanse, etc.) written on mint green paper.

Please call your pharmacy for all other medications.

We will call it in when approved. Thanks!

Patient Information

  • Pharmacy Information

 

Medication

    Prescription 1

  • Prescription 2

  • Prescription 3

 

Comments and Submittal

 

Verification