Piedmont Behavioral Services

Medication Refill/Query Form

Clinic try to make sure that all patients have enough supply of medications until their next scheduled appointment. If you already missed your appointment or you need to reschedule it, please call us OR request it online for appointment. Please fill all sections below and then click on Submit button at bottom. If there any issues then please use Laptop or Computer. You also can try to use Google Chrome browser on smartphone if needed. If you do not get any response within 24 hours then please send the request again.