Pediatric Broward, Margate and Fort Lauderdale Florida
Refill Request
The office will check for prescription requests each morning. (Prescription requests generated on weekends or holidays will not be reviewed until the next usual business day.) The nurse will notify you by return Email or telephone when your request has been processed and when to expect the prescription to be complete. In general, you can expect the prescription to be ready within 48-72 hours after your request has been received. If you need more urgent assistance, please call us by telephone.
PLEASE ONLY USE THIS EMAIL SYSTEM FOR PRESCRIPTION REFILLS. FOR OTHER QUESTIONS OR CONCERNS, PLEASE CALL OUR OFFICE.
Please note that you may only refill prescriptions by Email for medications that have been previously prescribed by Dr. Jose M. Leon at Leon & Kronberg Pediatric Center for chronic or recurring conditions. If you are unsure whether we will be able to fill your prescription, please call our office at (954) 974-4414.
Child's Full Name* :
Parent Name* :
Home Phone :
Email Address* :
Child Date of Birth* : MM/DD/YYYY
Prescribing Physician* :
Please note, all of the needed information about dosage and strength can be found on your medicine container.
1. *Enter the name of your first medication in the space provided below.
Strength or milligrams* :
How taken, choose one from list.* :
If other please specify :
Number of days supply needed* :
2.Enter the name of your Pharmacy in the space provided below.
Pharmacy Name :
Pharmacy Address :
Pharmacy Phone :
Please Note: Controlled Substances must be mailed or picked up
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