Request Prescription Refills

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.

First Name * Required
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Date Format: MM slash DD slash YYYY
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I would like to have my prescription * Required
Please Note: Controlled substances cannot be called in. These prescriptions must be mailed or picked up.
Prescription #1
Medication * Required
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Prescription #2
Medication
Dosage (in mgs/mls)
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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.
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Our Merrick office now offers immediate, after-hours care.

Weekdays: 5 p.m. – 10 p.m.
Weekends: 9 a.m -5 p.m.
Walk-ins welcome

516.992.4535

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What Our Patients Are Saying

View All Testimonials

"Dr. Ticker performed my shoulder surgery re-attaching and repairing torn tendons in both my rotator cuff ...

Ken Hehir

Procedure

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

Procedure

Pain Management

Performed By

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

Procedure

Wrist Fracture Cast

Performed By

Eric Price, M.D.

Use form below for prescription refills.

Prescription #1

Prescription #2

Pharmacy information

Our Merrick office now offers immediate, after-hours care.

What Our Patients Are Saying

"Dr. Ticker performed my shoulder surgery re-attaching and repairing torn tendons in both my rotator cuff ...

Ken Hehir

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

Laurie Jackson

"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

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