Prescription Refills

Prescription Refill Request Form

To request a prescription refill, please complete the form below. 

For all general medical questions, please call (515)776-7859 or email medication@bloomwomenswellness.org.

Our fax number is (515)328-4114.

Our Refill Policy

When you have one week’s supply of your prescription left, please complete the form below. Please allow up to 72 hours for your request to be honored and up to 5 business days for any prior authorization requests. 

We do not guarantee approval of all requests. If you’ve missed appointments, you may be asked to schedule an appointment so that we may provide safe and helpful care and comply with federal and state prescription regulations. 

Emergencies

We try our best to accommodate emergency refill requests as quickly as possible.

HIPAA Release Form

Please click the link below to sign the form allowing us to communicate your medication refill needs through the request form above. Thank you!

Medication Resources

To view a PDF of our policies, helpful tips, and answers to frequently asked questions, click the button below.