C. Scott Moreland, D.O.

• To obtain a prescription and/or a refill between appointments, complete the form below and click ‘Submit’
• To ensure accurate information, use your last prescription bottle to complete the form.
• You may request up to 3 different medications with 1 form. If more than 3, complete a 2nd form.
• If you have questions about your medication, please call the office or send us an email.
• We attempt to process your request as quickly as possible but please allow a 24-48 hour window to complete

Patient Information

Pharmacy Information:

Prescription Refill Information

(If med is not listed, choose 'Other' at the end of the drop-down med list and type the name in the box below)

Patients must be seen on a regular basis to obtain refills. To schedule an appointment, call 281-242-2595