Your Prescription information:               Date:
Your name if different from patient:
Select your physician click on arrow to scroll down: *
Patient's name:   *
Patient's DOB:
Medication #1 ---------------:   *
Medication #1 Dose (mg):   *
Medication #1 Directions:   *
Medication #2----------------:
Medication #2 Dose (mg):
Medication #1 Quantity:   *
Medication #1 Note:
Medication #2 Directions:
Medication #2 Quantity:
Medication #2 Note:
Last Appointment:   *
Your phone numbers. (At least one number is required.*)  (xxx) xxx-xxxx    Home:  
Last refill date --- :
Office:
Cell:
Are any of these new numbers?
                                                                or

2. MAIL: Enter YOUR address (not pharmacy) below to have your RX mailed to you.
Please allow THREE FULL BUSINESS DAYS for completion of your request.
Note that some mail-in pharmacies may take up to two weeks to fill your prescription.
Name:
Street 1:
Zip:
City:
State:
Street 2:
Is this a new address?
Expedited handling, rapid service, if received before NOON, reguest will be filled the same day, requests received after 12 NOON will be filled by NOON the next busness day, $15 fee:
Click here when finished to submt all information to AAFPC >
Atlanta Area Family Psychiatry Clinic, P.C. (AAFPC)
Email prescription refill request
Please allow THREE FULL BUSINESS DAYS for completion of your request.
Also note that some mail-in pharmacies take up to three weeks to fill your prescription.

Adderall, amphetamine salts, Concerta, Daytrana, Dexedrine, Dextrostat, Focalin (XR), Metadate, Methylin, methylphenadate, Ritalin, Vyvanse are Mail or Pick-up only.
To send: press the "Submit" button at bottom of page.
Fill in all appropriate fields,
( * = required field )
Use your mouse or "Tab" to go to next box or "Shift"+"Tab" to go back.
                                             or

3. Pick-Up: I will pick my Rx up at AAFPC office
        (M-Th 9 am - 5:00 pm; Fridays by NOON): (No/Yes): Your E-Mail address:
Your prescription delivery or pick up options:

All stimulants, Adderall, amphetamine salts, Concerta, Daytrana, Dexedrine, Dextrostat, Focalin (+XR), Metadate, Methylin, methylphenidate, Ritalin, Vyvanse and others
are Mail or pick-up ONLY.

1. FAX: is our PREFERRED and the most efficient method to communicate requests to pharmacies. (Not for stimulant medications.)
                                                              Enter your Pharmacy's  FAX number :
                 
                     (Your pharmacy telephone number for backup or verification) :


If you are picking up a prescription, call (770) 393-1880 ext 0 to verify that your prescription is ready before coming to pick it up.
We do not contact you to notify you if your Rx is ready.
Atlanta Area Family Psychiatry Clinic, P.C.
7000 Peachtree Dunwoody Rd, Building 16 Suite 100 ~ Sandy Springs, GA 30328
Telephone (770) 393-1880 ~ Facsimile (770) 393-1885
©  R. Slayden, M.D.
Atlanta Area Family Psychiatry Clinic, P.C.
Psychiatric and psychotherapeutic care for adults, children, adolescents and families
since 1977