Panacea Family Medicine
104 Spenryn Drive
Madison, AL 35758

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  • Online Prescription Refill

Welcome to our on-line refill request application. Please fill out the necessary information below and your request(s) will be answered via email within 2 business days. Manage your prescriptions accordingly and any emergent requests should be made by calling the office (256-772-4300) instead. Ultimately, the refill approval correctness will depend on the information you are required to provide. Any and all determinations are final, so please follow the simple guidelines below:


  • This form must be completed in its entirety and it is your responsibility to verify accurate dispensing of your medication.
  • This form may only be used for refill requests. (You will have to see 'Our Providers' for any medication he has not written for you before)
  • - You may not request controlled substances on-line.
  • - You must allow 2 business days for all requests to be met. Emergent requests should be made by telephoning the office directly.
  • - All decisions on refills by 'Our Providers' are final. If your request is denied, this means you will need to call the office and schedule an appointment with 'Our Providers' to discuss further.
Patient Info
Prescription Info

By submitting this request I attest under the perjury of law, I have read and agree to the terms and conditions of email communication. While identity of the requestor will be verified within reason, I furthermore attest I am the patient in question, the contact information I have supplied is secure and approved for responses and therefore waive any further HIPPA requirements.

PanaceaPFMFamily Medicine