Wilmington DE and Newark DE Psychiatrists Specializing in Cognitive Behavioral Therapy, Electroconvulsive therapy, Transcranial Magnetic Stimulation, Eye movement desensitization and reprocessing, Play Therapy, Post-traumatic Stress Disorder, and Depression

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Prescription Refill (fill the form below)

Note: If you are signed up with patient portal, you can continue to send your refill requests securely via the portal, if that’s more convenient for you.

Refill requests: Please note that it may take up to 3 business days to process prescription refill requests. Please plan to avoid any interruption in your medication(s) regimen by requesting a refill prior to running out of the medication. If you are using a mail order pharmacy, we recommend requesting your refills two weeks in advance before your medication runs out.

Some medications may require prior-authorization by your insurance. Our staff will do best to work with your insurance to get approval, but we can’t guarantee that your insurance will approve the medication. It may take up to two weeks to get approval.

Before requesting a refill, please check with your pharmacy first if any refills are left on your current prescription. Do not contact our office for refills without checking with your pharmacy first.

Medication refills will only be addressed during regular office hours (Monday- Friday 9 am – 5 pm). We do not fill prescriptions on weekends, Holidays, nights or after hours.

Refill Policy: If you are due for an appointment and you miss your appointment, your prescription refill request may be denied. Additionally, if it has been more than 6 months since we have seen you, we are unable to authorize a prescription or a prescription refill request without an office visit. Repeated no show or cancellations will result in a denial of refills.

Treatment with controlled substance requires strict adherence to treatment, including keeping your appointments. We will deny refill of controlled substance prescriptions for patients who do not adhere to treatment or miss their appointments.

Pharmacy: Prescriptions are sent to the pharmacy listed in our records. If you are requesting to change your pharmacy, please type in the pharmacy name, location, and pharmacy phone number in the “additional information” box.

If there is a problem with your prescription refill request or we require more information from you, we will contact you.

Request a prescription refill (existing patients only)

First Name (first 3 letters only)*
Last Name (first 3 letters only)*
Date of birth*
Date Format: MM slash DD slash YYYY
Phone number (last 4 digits only)*
Enter last 4 digits of phone number in file with us. If you do not have a phone number enter 0000.
Provider's name (choose one)*
- Sandeep K. Gupta, MD
- Parth M. Viroja, MD
- Shanila Shagufta, MD
- Zarrah Keshwani, MD
- Michal Tomaszewicz, PMHNP
- Julia A. Jordan, PMHNP
- Janet M. Brown, PMHCNS
- Michelle F. Lauer, PMHNP
Choose one by clicking inside the circle
Prescription Name*

Click "+" to add another prescription (if requesting more than one). If you are not sure how to spell, write exactly as it sounds or just write "not sure".
Has your pharmacy information changed from information on file with us?*
- Yes
- No
Please write the new pharmacy information in the text box below.*
Additional Information (if any)
Consent*
I acknowledge that I have read and understood the above refill request policies.