Prescription Renewal Request

Controlled Substance or Narcotic Refill requests must be made by calling our office at 603-537-1300.

If you are currently out of medication please DO NOT use this form. Please call our office at 603-537-1300.

* Required field. Please note: you will need to fill in all required fields in order to submit your request to us.

    Yes    No

    If you have additional prescriptions, add up to 5 by clicking the "+" button


    Our practice reserves the right to fill or deny your prescription renewal request. If your request is denied, our practice will explain the reason for the denial in a message sent to your patient portal Inbox. Our practice may also call you by telephone.

    Please describe any negative reactions or allergies to the medication in the “Additional Information” field. If you have not experienced any side effects, please type “None”.

    Note: We do not prescribe new medications without an office visit. Please do not ask us to fill a medication that we do not manage for you. Please contact our practice by telephone to set up an appointment with your provider. New prescriptions will not be accepted via this renewal page.

    We will process your refill(s) as soon as possible. However, please allow up to 72 business hours for all refill completions. Please check with your pharmacy first to see if your prescription is ready before calling our office.


    Thank you for your request.

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