Simplify your medication refill process. Existing patients can request refills by providing the following information:

Patients Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Pharmacy Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your prescribers name:

Controlled Substance

Yes

Medication(s) Name(s) and Dose(s):

For example: Zoloft 50mg once a day, Wellbutrin XL 150mg once a day. (please look at last prescription bottle for medication names and dose).

Select

For Refill or Pharmacy requests/inquires also feel free to CALL our patient advocates at (202) 918-7512 or EMAIL at jguzman@washinterpsych.com