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

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What Our Patients Are Saying

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  • "I cannot say enough about Dr. Krochak.  He is a highly skilled surgeon, who is compassionate, caring ...

    Eric Blasich

    Procedure

    Shoulder Labral Repair

    Performed By

    Ryan Krochak, M.D.

  • "I chose Orlin & Cohen for their extensive field in orthopedics and their participation in my healthcare ...

    Matt Dunseith

    Procedure

    Elbow Surgery

    Performed By

    Eric P. Keefer, M.D.

  • "Dr Krochak was absolutely amazing! When I first met him I could barely walk and now I am pain free. I’m ...

    Misha Chowdhury

    Procedure

    Knee Microfracture and Patella Stabilization

    Performed By

    Ryan Krochak, M.D.

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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.

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