OFFICE PRACTICES & BILLING READING ROOM Rx INSTRUCTIONS
FORMS NEW PATIENT / REGISTRATION FEES & INSURANCE
 
 

Rx Instructions

REFILLS

Please have your pharmacy fax a refill request to my office.

805.617.0509

OR

805.565.2113

 

TRIPLICATE Prescriptions

Some medications prescribed are categorized as controlled substances.  These prescriptions need to be written on a triplicate form and cannot be faxed.

If you need a triplicate Rx – please contact me at 805.570.6749.  Please allow 2-3 days.  You can either come and pick up the prescription once it is ready – or request that it be mailed to you.

 

CONSENT FORM FOR MINORS

*If you are a parent who is having me treat your child, please click on this link and sign the consent form.  Please mail, fax, or hand carry this form to my office.

Your cooperation is appreciated.

 

PLEASE READ this PATIENT Rx LETTER ~ new policy as of 2007

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

CONTACT US

Please read:

PATIENT Rx LETTER

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
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