To request a refill, you must be a current medical management patient with Mentavi Health.
To submit a request, you may use this link or the QR code below, which will take you directly to the submission forms on our website. Please select medication refill from the drop down menu in order to route your request to the most appropriate staff member.
- Please allow 2 business days for requests to be submitted to your provider.
- You will receive an email confirmation once the request has been submitted.
- Please only submit one ticket per refill.
Helpful Tip: Due to medication shortages, please stay in close communication with your pharmacist for any potential delays in filling your prescriptions. If you are not able to have your prescription filled due to the shortage, please complete a pharmacy transfer request form. Our providers recommend trying to stay at your preferred pharmacy if they will have stock available within one week.
Business Hours
Monday-Friday
9:00am-5:00pm EST