Dr. Refills — Refill Request

✅

Request submitted!

A board-certified physician will review your request shortly. You'll be notified by email when a decision is made — no charge if not approved.

Need to change your pharmacy, ask a question, or share a concern?
Email us anytime at [email protected]

HIPAA-secure · Board-certified MD · LegitScript Certified

Before we begin

Telehealth Consent

California BPC §2290.5

I understand this is an asynchronous telehealth service. My information will be reviewed by a licensed California physician, and my prescription history may be verified through Surescripts. No real-time interaction occurs during intake. I consent to telehealth services per California BPC §2290.5. I am 18 years of age or older. The physician service fee covers the review only — it does not include the cost of my medication, which is filled and billed separately at my pharmacy. No subscription or recurring charges apply.

I have read and agree to the above. I understand this is a physician-reviewed telehealth service.

Telehealth services provided by Iwan S. Nyotowidjojo, M.D., CA License #A167115 · A Professional Corporation