Free Download – Medication Dependence and Stockpiling

Here’s your free offer:

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Template for requesting extra medication from your physician PDF

Template for requesting extra medication from your physician

Use the above template to take to your physician to initiate a discussion regarding dispensing extra medication.  Please don’t wait until your doctor is about to go out the door to express your request. Your doctor will be much more receptive if you ask at the very beginning of an office visit. Remember, breaking your word about returning for regular check-ups is a deal-breaker, and your doctor will likely never prescribe extra medication again.

If you need multiple medications, it would be best to make an appointment just for this reason, as it may take 10-15 minutes to write out several prescriptions by hand.  You probably won’t be submitting these prescriptions through your insurance, if they go beyond the next 3 months, and you may want to take them to a discount pharmacy.

If you find the template useful, please leave a comment below.

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
This entry was posted in Expired medications, FREE OFFERS, Medications, Prescription Medications, Shelf life, Stockpiling medical supplies, Stockpiling medications. Bookmark the permalink.

2 Responses to Free Download – Medication Dependence and Stockpiling

  1. Russ W says:

    Looking forward to seeing the form.

  2. Doug F says:


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