Pediatric Associates of Lawrenceville

Please complete and submit the following form and one of PAL's qualified nurses or staff will process your request as soon as possible.

Fields marked with an asterisk (*) are optional. All other fields are required.

Order a Prescription Refill from PAL

Parent’s full name
Child’s full name
Child's date of birth
Contact telephone number
Alternate telephone number*
Contact e-mail address
Contact preference	Respond by telephone Respond by e-mail
Pharmacy name
Pharmacy telephone number
Prescriptions to refill

Prescription Refill Disclaimer
PAL will refill prescriptions with your pharmacy by telephone in accordance with Georgia's HIPPA regulations.

Some prescriptions, including those used to treat Attention Deficit Hyperactivity Disorder (ADHD), asthma, and allergies, may require a doctor's visit before they can be refilled.

Make an appoint to visit PAL online.
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Please allow our staff 1 to 3 business days to respond to your online inquiry. If you experience difficulty completing this form, or would rather contact PAL by telephone, please call 770.277.6725.
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