PAA Pain Management Prescription Refill Policy Your prescription needs can be taken care of as part of your regular office visit, at no extra charge. Our providers make every effort to provide long-term prescriptions and automatic refills at that time, to avoid your having to contact us separately to request a refill. Please be aware that refills take valuable staff and physician time to address. All patients who request prescription refills at any time other than an office visit are charged a service fee that varies based on the number of medications. This includes prescriptions that need to be called in, faxed, or mailed to a pharmacy, and prescriptions that must be rewritten. What will my fee be? • • • $15 for up to 3 medications $30 for up to 6 medications $45 for up to 9 medications Prescription refills will only be handled Monday-Thursday from 9:00am to 3:00pm. Absolutely no refills will be given on Friday. Also, all narcotics will require an office visit, no exceptions. Please schedule office visits in advance to be sure you do not run out of a medication. ________________ _____________________ _______________ Print Name Patient Signature Patient/Guardian Date
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