Prescription Refill Request

If you are a current patient, and you need a prescription refill, we will be able to help you with this. Please write your request bellow. One of our staff will contact you in the next business day.
Please be specific about your name and date of birth, the name of the medication, dosage and ammount.

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

Your Name:

Your Phone Number:

Your Email Address:

Preferred Date and Time:

Your Message:

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

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Mariela Fuenmayor, MD

Psychiatry - Psychotherapy

Prescription Refill Request