Medication Refill Requests
If you are a current patient of Dr. William Hayes, Dr. Asma Mian, Dr. Sara Popkin or
Dr. Jennifer Kearney 
and  your prescription runs out before your next scheduled appointment, please enter the information below. Prescriptions will be filled within 2 full business days (not including weekends). Please allow up to 6 business days for mailed prescriptions to arrive. 


Please Enter the Following Information:

First Name: *
Last Name: *
Doctor: *
Medication: *
Medication Dosage and Instructions:
how much - 
how many times per day - 
Phone Number: *
Method of Delivery:
(please choose one)
- Pick up at the Office
- Mail to Home Address
- Phone in to Pharmacy
Mailing Address
(if Mail to Home Address)
OR
Pharmacy Name and Phone Number
(if Phone my Pharmacy)
Email: *


A reminder that controlled substances such as the stimulant medications Ritalin, Dexedrine, Adderall, Vyvanse, Evekeo, Daytrana, Concerta, Metadate & Focalin cannot be called in and require a written prescription. Your insurance prescription plan may offer 90 day supply discounts, however the State of New Jersey does not allow clinicians to write prescriptions for a 90 day supply of controlled substances even if they a filled out of state.*

*http://www.njleg.state.nj.us/2008/Bills/A4000/3799_I1.PDF

For information on your medication visit our Medication Information page by cliking here.


Psychotropic medications require regular monitoring to ensure that they are working as intended, and to screen for potential side effects. 

Your doctor will provide you with enough refills to last until your next appointment. If you rescheduled your appointment and need a refill please fill out the above information to obtain your medication. If you do not have a follow up appointment, please call the office to schedule one. 

Some insurance plans make use of pharmacy plans that delay the approval of prescriptions by requesting prior-authorization. Please be advised that it can take our office up to 72 hours to process their requests. This if often due to their lack of response to our phone calls to obtain their forms. If their offices do not answer our calls within 10 minutes, we will call you to request you contact them to have forms forwarded to our fax at 609-419-0400. We also encourage you to report any delays to the NJ Department of insurance managed care complaints by clicking the link:

http://www.nj.gov/dobi/division_insurance/managedcare/mcfaqs.htm

It is our policy at Alexander Road Associates to see patients every 4 months to ensure that we are providing safe and appropriate care.  If you have not been in for a follow up visit in over 4 months our staff will request that you schedule a follow up visit.


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