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Rx refill request – Message Only
If it has been more than 12 months since your last visit or if this is a new prescription you must schedule an appointment with a provider. If you are out of a medication and need a refill, our providers may be able to provide a short term supply until you are seen for an appointment. We will need your name, date of birth, pharmacy name and phone number, location, medication name, dosage, and quantity taken daily of the medication. It may take up to 72 business hours to fill your prescription.
If you need to have a referral written for a specialist, please call our office. We will need your full name, telephone number, name of specialist, phone number of the specialist, chief complaint, and date of appointment. Referrals must be requested 72 hours in advance of your appointment. Please note that if this is a new problem or if we have not seen you in more than 12 months, you must be seen by a physican before we can write a referral.
If you have a billing question please contact our billing office at 301-258-1904. If you would like to make a payment on your account, you can either call our office to make a payment over the phone or mail payment to our office.
Form Completion Policy
If you need to have forms completed by your health care provider please be aware of the following:
- Depending on the nature of your form, you must have had a complete physical in the last 12 months or you will need to schedule one in order for us to complete your form.
- If you need a prior authorization form for your insurance company to pay for your medication you may need an office visit, depending on the individual form.
- You will be charged either $15.00 for short forms or $50.00 for long or complex forms. (this is not covered by your insurance)
- If your form asks for immunization history you must supply us with a copy of your shot records or have labs drawn to provide proof of your immunity status.
- You will need to bring your form with you to your appointment, we do not have MVA, camp, school, adoption or other forms.
- We cannot complete forms over the phone.
- If you are uncertain what applies to your particular form please ask our receptionist to review your form and direct you appropriately.
Missed Appointment Policy
There is a $25.00 charge for all missed regular office visit appointments and a $50.00 charge for all missed physical appointments not cancelled at least 24 hours in advance.
Prescription Renewal Policy
Please be sure to get any medication renewals that you will need between now and your next appointment while you are here today.
When a provider writes a prescription for medication it is for the quantity they believe will last until the next time you are due to return. When you reach your last refill it is time to call and schedule your next appointment.
- You must have been seen by one of our healthcare providers in the last 12 months.
- We must have a current copy of your insurance card & up to date registration form on file.
- You must request your referral two business days in advance of when you will be picking it up.
- If the referral is at the direction of another healthcare provider you must supply a copy of the order with your request.
- If the referral is for radiology, physical therapy or chiropractic care it must be ordered by a healthcare provider.
- Please leave your name, daytime contact number, current insurance provider, diagnosis or reason for referral and the spelled name of the specialist or facility to whom you are requesting a referral.
- If you wish your referral to be mailed to you, you may leave self addressed, stamped envelopes at the front desk for your chart.