OBSTETRICS & GYNECOLOGY
17722 Talbot Road South  Renton, WA 98055   425.228.0722
16850 SE 272nd Street  Covington, WA 98042  253.630.3644

PROVIDERS

LOCATION
REFILL REQUESTS
  MEDICAL RECORDS
 APPOINTMENTS
 ONLINE PAYMENTS
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PATIENT RESOURCES  HEALTH INFO PREGNANCY INFO  VISIT SURVEY   FORMS    PRIVACY POLICY

                   
                    

 


Prescription Refill Requests


In most cases, your health care provider has written a prescription for you for one year.  

In all cases, we ask that you please call your pharmacy before making a refill request.  If your pharmacist has a question, he will call our office.  

This will save both you and our office time!

If you know you need your doctor's permission for a refill, please use this form.  Your request will be e-mailed to our office.

Your prescription refill request (e-mail message) is sent to our clinic via the internet. Although we feel confident your messages to our clinic are secure,  the internet offers no absolute guarantee of confidentiality in regard to e-mail.  Please consider this fact when sending sensitive information.

If you like, you may call our office at 425-228-0722

 

Pharmacy Information:

Pharmacy Name: 


Location of Pharmacy:



Daytime Phone Number:

 

Prescription Information
(Please include dosage)
  

 

Patient Information

Name:

Date of Birth:

Address:

Daytime Telephone:

E-Mail:

Physician:

  

 

 

 








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