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
Last Name * Required
Date of Birth - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Daytime Phone * Required
Email Address * Required
My Primary Physician is: * Required
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
Dosage (in mgs/mls) * Required
Prescription #2
Medication
Dosage (in mgs/mls)
Frequency
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 Name * Required
Pharmacy Address * Required
Street Address City State / Province / Region ZIP / Postal Code
Pharmacy Phone * Required
Pharmacy Fax * Required
Comments

* Required Fields

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

What Our Patients Are Saying

View All Testimonials

"Choosing Dr. Price came about by a combination of events. First, my training facility recommended him ...

John Davide

Procedure

Rotator Cuff Surgery

Performed By

Eric Price, M.D.
"Passion is not only a gift from God, it is what drives us to be the best. Dr. Price's passion and expertise ...

Dr. Bobby

Procedure

ACL Surgery

Performed By

Eric Price, M.D.
"I wanted to take a moment to thank the staff, both in Massapequa and in Merrick, for helping me to rehab ...

Raymond Stambouli

Massapequa, Merrick

Procedure

Physical Therapy

Performed By

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

"Choosing Dr. Price came about by a combination of events. First, my training facility recommended him ...

John Davide

"Passion is not only a gift from God, it is what drives us to be the best. Dr. Price's passion and expertise ...

Dr. Bobby

"I wanted to take a moment to thank the staff, both in Massapequa and in Merrick, for helping me to rehab ...

Raymond Stambouli

Request an Appointment