Patient Referral Requests
When your health care provider decides that you need special medication or a referral to a specialist, our office will process the authorization request to your health insurance company for you.
Please open, and fill out the following referral request form. You may then print it by clicking on the print button or e-mail it by clicking on the e-mail button. If you print it, you can either send the referral request to our office or simply bring it in with you on your next scheduled visit.
Note: If you are an HMO patient and require a referral, we will need to have the information that is listed on the following form prior to our office processing the referral. Please note that referrals to a specialist are generally written for a condition that has been previously treated by your primary care provider.
Referral requests take on average one week to complete unless deemed medically urgent by your primary care physician.
We prefer that you coordinate all your prescription refills during regular routine office visits whenever possible. However, we are available to authorize appropriate prescription refills from 9:00 AM to 4:00 PM Monday through Friday by calling the office.
For local pharmacy refills, please make sure you include the following information for confirmation:
Your medicine dosage and frequency
Your telephone number
The telephone number for your pharmacy
Mail Order Prescription Refills
Many of our patients participate with mail order prescription plans. We have always tried to work with these plans on behalf of our patients. However, several of these plans have adopted policies and procedures which place too much demand on our staff’s time and takes them away from patient care. These changes include: burdensome paperwork to fax prescriptions, refusing to contact us regarding prescription refills, keeping our staff on hold on the telephone for very long periods of time to phone in refill in formation, and refusing to accept prescription transfers from local pharmacies. We have thus implemented the following policies:
New prescriptions at the time of an office visit: Your physician will give you written prescriptions to mail to your plan. If your physician determines that you need to start the medication immediately, he/she will provide you with a second 14-day prescription to take to a local pharmacy.
New prescriptions by phone: There may be times that your physician prescribes something new for you over the phone. Any medication needed immediately will be called to a local pharmacy. Long term prescriptions or any prescriptions not needed immediately will be mailed to you to mail to your plan.
You need to plan at least 2 weeks in advance. It is preferred that you send us a note with the medication refills you need, and a self-addressed stamped envelope. We will mail the prescriptions back to you. However, we are also willing to fax the prescription to your mail-order pharmacy, if you request us to do so. We will NOT contact them by phone.