Patient Forms

Please download, print and complete the appropriate form; bring to your appointment.

New Patient Questionnaire

New Amputee Patient Questionnaire

Follow-up Patient Questionnaire

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Prescription Refills

Please call your pharmacy first, using the number located on the prescription bottle.  Many times your prescription can be refilled without authorization.

Should your prescription require an authorization, your pharmacy will contact our office for you.

We retrieve our prescription requests each business day; please allow at least 48 hours to process your prescription request.

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Prescriptions We Refill

The following are the common prescriptions that we refill. 

Your primary care provider or other specialist will need to refill all other medications, including narcotics. 

• Neuropathic agents (gabapentin, Lyrica, amitriptyline, etc.)
• Antidepressants (citalopram, Cymbalta, etc.)
• Bladder Medications (Detrol, Ditropan)
• Bowel Management Medications (docusate, suppositories, etc.)
• Spasticity medications (baclofen, tizanidine, dantrolene)
• Neurostimulants (amantadine, Ritalin, Provigil)
• Pain Medications (NON opiate)

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New Prescriptions

For a new prescription or a dosage adjustment request, please call the main clinic at 425.899.3139.

When leaving your message, please speak clearly and slowly and leave:

• Your name
• Phone number
• Date of birth
• Name and phone number of your pharmacy
• Name of the medication you are requesting

For those medications requiring dosage adjustments, please read the directions on the label of your current prescription bottle then include any special or new instructions.