Medication Refills - Brave Health

Medication Refills

Required Fields (*)

To request a medication refill from Brave, please fill out this secure form.

Patient Information

Patient Name *
Patient Email *
Patient Mobile Phone ########## *
Birth Date *
Medication Requested

Request Information

Person Requesting *:
Requestor Name *
Requestor Phone ########## *
Relation to the patient *
Date Medication Last Taken *
Date Medication will Run Out *
Additional Notes regarding last taken / when medications will run out:
Any recent side effects, not discussed with provider? *
If yes, describe:
If you are a female, any changes in pregnancy / breastfeeding since last visit with your provider? *
If yes describe:
Any changes to your preferred pharmacy?

If you are requesting a medication change or dosage adjustment, please do not use this form. Please text us at +1-305-902-6347 to schedule an appointment with your provider.

If you have not seen the psychiatrist or psychiatric nurse practitioner in the last 2 months your refill request will be denied.

Please note that past due balances and missed appointments may delay your refills.

Refills can take up to 5 business days to process so please plan accordingly (does not include weekends and holidays). Please do not call the nurses line unless it has been more than 5 business days.

All medications are sent electronically directly to the pharmacy.