HopeMillsPeds
   


Policy

- We Cannot Call in ADHD Medications or Write Prescription if child has not seen our    Doctors in last 3 Months for ADHD and in    last 6 months for other conditions. It takes    upto 48 hrs to process your prescription request

Please Call your Pharmacy in 48 Hrs to Check for your prescription request.

                   
Patients First Name
Last Name
DOB
 
SS #
   
Parents Name
Relation
Telephone No
Cell Number
Email
         
   
Pharmacy Name
Pharmacy Tel.no.
   
Medication Name
Dose/Strength
   
Suppliers Requested
Suggestions