Tel: 516-326-0707   
Fax: 516-326-1101   
E-mail: info@lungmd.com   
3003 New Hyde Park Rd., Suite 303   
New Hyde Park, New York 11042   
HomePracticeDirectionsPre-RegistrationPrescriptionsPatient Requests
 
 

 

 

  
   
 
     
We encourage use of the Web site for obtaining renewals of previously prescribed medications used on a chronic basis. Please do not request prescriptions for new medications or medications needed for acute problems such as antibiotics. Patients can also have their pharmacy call the office during working hours for renewals.
     
Patient Information:    
First Name:
 
 
Last Name:
 
DOB:
 
 
Phone 1 :
 
Name of Medication :  
Dosage:
  
 
Times a Day :
  
Doctor's Name:
 
 

Brand or  Generic :

 
Duration of Therapy:
 
# of Refills Requested:
 
Request By Mail:  
Pharmacy Phone#:
 

Your E-mail Address:

 
   
 
 
 

Please note this message is NOT encrypted.
If there is a problem with your renewal we will call you or communicate this via E-Mail. Please allow 4-5 days for prescriptions to arrive by mail or 48 hours by phone.

 

  
 
 
 
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