Patient Portal
Prescription
Refill Request
Submit your refill request below. Your physician team reviews every request and will contact you to confirm before your prescription is processed and sent.
Medication Refill Request
Complete all three sections. Fields marked are required.
Patient Information
Please enter your first name.
Please enter your last name.
Please enter your date of birth.
Please enter a valid phone number.
Please enter a valid email address.
Your Clinic Location
Please select your clinic location.
Medication(s) to Refill
Pharmacy Preference
Supply & Notes
Request Summary
How Did You Find Us?
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Request Received
Your refill request has been submitted. Your Body Symmetry MD physician team will review it and contact you within 1–2 business days to confirm before processing.
For urgent needs, call (833) 789-2639 directly.
Common Questions
Refill Request FAQ
Complete the secure form above with your name, date of birth, clinic location, medication name, and any relevant notes. Your physician team reviews requests within 1 to 2 business days and will contact you to confirm before your prescription is sent to your pharmacy.
Most refill requests are reviewed within 1 to 2 business days. Complex requests or those requiring updated labs may need a brief follow-up call before the prescription is finalized. For urgent needs, call (833) 789-2639 directly.
No. This form is for existing Body Symmetry MD patients with active prescriptions only. New patients must complete an initial consultation before any prescription can be written. Call (833) 789-2639 or visit our contact page to schedule.
Body Symmetry MD works with several PCAB-accredited compounding pharmacy partners including Compounding Pharmacy of America, Hallandale Pharmacy, Mix with Integrity, and Texas Star Pharmacy. You can specify your preferred pharmacy in the form. If you're unsure, note that in the form and your care team will confirm with you.
Not Yet a Patient?
Your first consultation is free. Physician-supervised protocols designed around your labs, your goals, and your life.