Medication Refill Request

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YOU CAN ONLY USE THIS PROMPT IF YOU ARE ASKING FOR A REFILL OF YOUR MAINTENANCE MEDICATION (such as for blood pressure, diabetes, thyroid, cholesterol, depression/anxiety, allergies, etc). For all others, including antibiotics, please call the clinic.

1. Non-Controlled maintenance prescription refills will generally be allowed if a patient has been seen by Dr. Go within the last 11-months period.

2. Controlled Pain/ Anxiety & Depression/Psych Prescriptions will generally be allowed if a Patient has been seen by Dr. Go within the last 2-months period.

For Faster and Convenient refills, we strongly recommend pharmacist-owned **RxAll PHARMACY located in Suite C, Phone: 734-463-3300

Fill in these details below if you meet any of the 2 criteria above:

    Patient Name

    Patient DOB:

    Patient Phone Number:

    Name of Pharmacy: (see note below)

    Pharmacy Address:

    Pharmacy Phone Number:

    Name of Medication:

    Medication Dose:

    Medication Dose Frequency:

    **If **RxAll is your Pharmacy, you do not have to fill out the rest. Someone at the RxAll Pharmacy will contact you directly about your prescription refill request.

    DISCLAIMER: This website is intended for Dr. Go's patients only. It is purely informational and should not be taken as medical advice. If you have questions regarding any material on this website, pls. consult with Dr. Go.