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Prescription Request.

For established patients only: please complete this form to the best of your knowledge. This form is for routine prescriptions only. For antibiotics, pain relievers and controlled medication, please call or fax the office. All prescriptions must be electronically prescribed, as per NYS law.


NOTE: Electronic prescription transmittals requested here on a business day may take up to 24 hours to be processed and received at your pharmacy. Please call us if you need something urgently refilled before then.

Prescription #1 Details

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