top of page

Refill Request

Please complete the refill request below. There will be a charge of $45.00 for each request.

Steps to follow:

1. Please complete ALL FIELDS on the form below.

2. One of our clinical staff will review your request during business hours.

3. A Link for payment will be automatically received once the refill has been approved to be sent. 

4. Once payment is received the refill will be sent to the requested pharmacy. 

* We will only review refill request of patients of FitBodyMD and of medications that our providers have previously prescribed. 

** ALL CONTROLLED Substances Requests will be verified through PMP AWARE (Link: PDMP).

Date of Birth

©2015-2024 POWERED BY FiTbodyMD.me

FiTbodymd™

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. Fitbodymd and Jaime A Salas Rushford MD, make no representation and assumes no responsibility for the accuracy of information contained on or available through this web site, and such information is subject to change without notice. You are encouraged to confirm any information obtained from or through this web site with other sources, and review all information regarding any medical condition or treatment with your physician. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY SEEKING MEDICAL TREATMENT BECAUSE OF SOMETHING YOU HAVE READ ON OR ACCESSED THROUGH THIS WEB SITE.

bottom of page