Please complete the secure form below and press submit. If there is a problem with your prescription refill request or we require more information from you, we will contact you by phone.


All requests will be processed within 24 – 48 hours during regular business hours, Monday – Friday, 8:30 am – 5:00 pm, excluding holidays. If you require an immediate refill or have a question, please contact our office.


Please complete the following information in its entirety.

  • Date Format: MM slash DD slash YYYY
  • Please Note: Controlled substances cannot be called in. These prescriptions must be mailed or picked up.
  • Prescription #1
  • Prescription #2
  • Pharmacy information

    Please tell us which pharmacy you would like us to call your prescription into. Please be precise as there are many pharmacies and pharmacy locations.

  • Pharmacy Address * Required

* Required Fields

What Our Patients Are Saying

View All Testimonials learn-more-arrow
  • "Dr. Ticker performed my shoulder surgery re-attaching and repairing torn tendons in both my rotator cuff ...

    Ken Hehir


    Rotator Cuff Surgery, Bicep Surgery

    Performed By

    Jonathan B. Ticker, M.D.

  • "I came to Orlin & Cohen after a car accident 5 1/2 years ago that left me with multiple herniated ...

    Laurie Jackson


    Pain Management

    Performed By

    Alfred F. Faust, M.D.,Daniel Yadegar, M.D.

  • BalaramStack_150x150_acf_cropped
    "Without Dr. Price, I wouldn't have been able to stay in the water for the winter in Hawaii to catch those ...

    Balaram Stack, Pro Surfer


    Wrist Fracture Cast

    Performed By

    Eric Price, M.D.

Hero Shape

Request an Appointment

Please fill out the form below. We will respond within two hours during normal business hours. To request a follow-up appointment, click here. Prefer to speak to a person? Call 516.536.2800.

* Required Fields