John B. Lochridge, M.D.


3050 S. Atlanta Road.

Smyrna, GA  30080

770-436-8383


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Rx REFILL REQUEST

 

 
 

While you are taking medications, Dr. Lochridge would like to see you for a medication management appointment approximately every three months.  If you are due for an appointment, or if you are unsure if it is time for you to see Dr. Lochridge, please call the office at 770-436-8383 to make your refill request.

Requests for refills are not automatically approved.  Dr. Lochridge has to review each request.  Please allow 2 business days to complete the process.

Remember, certain medications such as Adderall and Ritalin cannot be phoned in but must be hand written which will require you to pick them up from our office.
 

 
 
 
Requested By: Daytime Contact #
Pt. First Name: Pt. Last Name:
 

We use an electronic prescribing service as recommended by the federal government and other national healthcare improvement organizations. In order to accurately transmit your prescription, the following section must be completed in full.  All of this information can be found on your prescription bottle.

 
Pharmacy Name Pharmacy Phone
Pharmacy Street Address  
City

State

Zip

 
1st Refill Requested:
Medication Dosage
Directions Quantity

Date of last refill:

 
2nd Refill Requested (If Applicable):
Medication Dosage
Directions Quantity

Date of last refill:



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John B. Lochridge, M.D., P.C.