MEDICATION REFILL | American Psych Care

Patient Name

Phone

Home Address

Provider Name

Medication name and dose refill request

Pharmacy Name

Pharmacy Name and address

"NO-SHOWS": A 'no-show' is someone who misses an appointment without canceling it in the proper manner. A failure to be present at the time of the scheduled appointment will be recorded in your medical record as a 'no-show'. If you are a 'no-show' for your first appointment with a physician, physician assistant, or nurse practitioner, you will be charged $200. If you are a 'no-show' for your first appointment with a therapist, you will be charged $100. A credit card or debit card is required prior to your first appointment. For each 'no-show' follow-up appointment, you will be charged $50. All 'no-show' fees must be paid prior to your next appointment. If you have three (3) or more 'no-shows', you may be discharged from the practice. There is a $10 fees for medication refill.

American Psychiatric Care

Child, Adult & Geriatric Psychiatric Clinic
TMS Brain Stimulation Center
Tel: 410 670 3076

American Psychiatric Care

White Oak Adventist Hospital

Medication refill request

Is TMS is right for me?

American Psychiatric Care

White Oak Adventist Hospital

American Psychiatric Care

Child, Adult & Geriatric Psychiatric Clinic TMS Brain Stimulation Center Tel: 410 670 3076

American Psychiatric Care

White Oak Adventist Hospital

Medication refill request

Is TMS is right for me?

American Psychiatric Care

White Oak Adventist Hospital

Child, Adult & Geriatric Psychiatric Clinic
TMS Brain Stimulation Center
Tel: 410 670 3076