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Refill Request

EXPRESS WEIGHT LOSS CLINIC

Non-surgical medical weight management

Refill Request

Refill requests will not be approved unless the following apply:
  • Refill requests only approved for more than 1 month purchases.
  • Submit request at least 3-5 days before you are out of medication.
  • Requests will only be approved if it has been 30 days from your last refill.
  • Allow up to 48 hours for refills to be processed.
  • Refills requested on the weekend will be returned to the pharmacy by Monday, 5pm CST.
Patient Name *
Date of Birth *

Click submit below to be routed to our scheduling page. You have to schedule using the calendar to be seen via eVisit

For downloadable versions of these forms and waivers, please visit our Forms Page