{"id":389,"date":"2025-02-07T09:31:09","date_gmt":"2025-02-07T14:31:09","guid":{"rendered":"https:\/\/ctrfamilyguidance.cfghealthnetwork.com\/patient-info\/patient-refill-request-form\/"},"modified":"2025-03-11T12:13:46","modified_gmt":"2025-03-11T17:13:46","slug":"patient-refill-request-form","status":"publish","type":"page","link":"https:\/\/ctrfamilyguidance.cfghealthnetwork.com\/?page_id=389","title":{"rendered":"Refill Requests"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"389\" class=\"elementor elementor-389\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1cb6bb1c e-flex e-con-boxed e-con e-parent\" data-id=\"1cb6bb1c\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ff4b369 elementor-widget elementor-widget-heading\" data-id=\"ff4b369\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Patient Refill Request Form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6192879 elementor-widget elementor-widget-heading\" data-id=\"6192879\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Welcome to the NEW Center for Family Guidance On-Line Refill Request Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-24305810 elementor-widget elementor-widget-text-editor\" data-id=\"24305810\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>This convenient form will allow you to submit a request to have your medications refilled without having to call the office directly. Please allow 5 business days for your request to process. If you have any questions, you may call the office of your prescriber and speak with the prescriber assistant. If you have been seen by telehealth and are not sure of the office of your prescriber, please call our Marlton office. All fields must be completed to ensure accuracy, any missing information may cause a delay in processing your request. Please note\u00a0<b>in order to ensure the safety of our patients, we may not be able to complete refill requests if you have not seen your prescriber for a follow-up visit within the timeframe suggested by your prescriber at your last visit<\/b>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-88b5ce6 e-con-full e-flex e-con e-child\" data-id=\"88b5ce6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-698b3a5 elementor-widget elementor-widget-heading\" data-id=\"698b3a5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Insurances Accepted<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-841d8ec bullets-purple elementor-widget elementor-widget-text-editor\" data-id=\"841d8ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>Aetna<\/li><li>AmeriHealth<\/li><li>AmeriHealth Administrators<\/li><li>Blue Cross Blue Shield Cigna<\/li><li>Horizon Blue Cross Blue Shield<\/li><li>Independence Blue Cross Blue Shield<\/li><li>Keystone<\/li><li>Magellan<\/li><li>Medicare<\/li><li>Tricare<\/li><li>Quest<\/li><li>Qualcare and Tri-State\u00a0<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-3c4620f e-con-full dark-bk e-flex e-con e-child\" data-id=\"3c4620f\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;gradient&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-9cdadfa elementor-widget elementor-widget-heading\" data-id=\"9cdadfa\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">If you are new to CFG, please review our <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-431a3bc elementor-widget elementor-widget-heading\" data-id=\"431a3bc\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\"><a href=\"\/patient-info\">Patient Information page<\/a><\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ed7868d elementor-widget elementor-widget-shortcode\" data-id=\"ed7868d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><iframe src='https:\/\/practisforms.com\/cfghealthnetworkcom\/forms\/6egpqgjf6htr' loading='lazy' width='500' height='500' style='width:100%; height:500px; border:0; overflow:scroll;' class='practis-forms' title='secure online form'><\/iframe><script src='https:\/\/practisforms.com\/_iframe-resize\/iframeResizer.min.js'><\/script><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Patient Refill Request Form Welcome to the NEW Center for Family Guidance On-Line Refill Request Form This convenient form will allow you to submit a request to have your medications refilled without having to call the office directly. Please allow 5 business days for your request to process. If you have any questions, you may [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":383,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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