• Prescription Request Form

    The doctors will now be E-scribing your prescriptions. Please be sure and fill in the preferred pharmacy information below. If you have trouble with the pharmacy not showing the prescription, please speak to the Pharmacist and ask them to check for escribed prescriptions. Please be advised that you must call the pharmacy and request that each month's prescription be filled. In most cases this is not done automatically.
  • We are aware of the ADHD medications shortages: Please call your pharmacy and check the availability of your prescription BEFORE REQUESTING YOUR PRESCRIPTION.

  • Please tab through all of the required spaces to access the submit button at the bottom of the page. 

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    Pick a Date
  • Failure to put a correct appointment date may delay your prescription request. Please leave this area blank if you do not have an appointment scheduled.

  • Fields with an asterisk (*) are required.

     

    Prescription Fees are $15 per prescription written and $35 RUSH fee

     

    Dr. Burnside, Dr. Spratley and Dr. Lee charge $15 for each stimulant prescription written between appointments. Stimulant medications include Adderall, Concerta, Ritalin, Vyvanse, etc. 

    Non - stimulant ( Zoloft, Prozac etc. ) please phone your pharmacy and have them FAX a prescription request for you to 210-496-2804 at no charge. Stimulant prescriptions will now be escribed. .If you need to check the status of your prescription please phone the office. Due to the number of prescriptions we process, we can not call to advise you of the status of the prescription. MOST of the time these are done same day but we do not make that guarentee. 

     

    If you absolutely need a guarantee that your prescription will be ready, you may consider the "Expedited prescription request", but it will be $35 per prescription in that instance. If your prescription is requested BEFORE NOON, it will be ready within 24hours. If after noon, it will not be ready until the NEXT BUSINESS DAY.

  • 1st Prescription Request $15

  • Please refer to your last prescription bottle or container to complete the information requested. Missing or incomplete information will delay your prescription.

  • 2nd Prescription Request + $15

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  • 3rd Prescription Request + $15

  • Contact Information

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  • AFTER YOU HIT SEND, YOU WILL BE DIRECTED TO A PAYMENT PAGE.

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