Medication Refill Request Medication Refill Request Have you had an appointment in the last 30 days?* Yes No Do you have an appointment scheduled with one of our psychiatrists in the next 30 days?* Yes No Please select which office you go to…*LancasterHarrisburgRiver Rock AcademyHilltop AcademyClient Code (if known) Patient First Name* Patient Last Name* Patient Date of Birth* Medication you want refilled* Please name the pharmacy you use (if you know the address, phone number, or fax number please list this as well)*Since you have indicated that you have not had an appointment in the last 30 days, and that you do not have an appointment schedule in the next 30 days our staff will NOT be able to refill your medications. Please contact the front desk to get schedule for an appointment to get your medications refilled Lancaster:717-391-0172 Harrisburg: 717-525-9804 Thank you, and we look forward to being able to assist you. Δ