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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  • "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.

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    "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.

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