Your Prescription information:                Date: 
Your name if different from patient: 
Select your physician click on arrow to scroll down:    *
Patient's name:    *
Patient's DOB:    *
Medication #1 ---------------:  *
Medication #1 Dose (mg):   *
Medication #1 Directions:    *
Medication #2---------------:
Medication #2 Dose (mg):
Medication #1 Quantity:   *
Medication #2 Directions: 
Medication #2 Quantity:
Comments/Note:
Last Appointment:Date : *
Your preferred contact number. (xxx) xxx-xxxx *
Name:
Street 1:
Zip:
City:
State:
Street 2:
Expedited handling, rapid service, if received before NOON, reguest will be filled the same dayrequests received after 12 NOON will be filled by NOON the next busness day, $25 fee: Select "YES" for expedited handling. You must ALSO click "Submit" below to complete:

Click here when finished to submit your request to AAFPC >>


Controlled Medication Rx's
All stimulants; Adderall, amphetamine salts, Concerta, Daytrana, Dexedrine, Dextrostat, Focalin (+XR), Metadate, Methylin, methylphenidate, Ritalin, Vyvanse and others
 are Mail to you or ePrescribe ONLY.


Drs Coffman, Kirsch, Nitsche, Perez and Robert Slayden are ePrescribing physicians and REQUIRE that you submit your PHARMACY TELEPHONE NUMBER so that your Rx may be submitted directly to your pharmacy electronically.
Note that some mail-in pharmacies may take up to two weeks to fill your prescription. 

Please allow THREE FULL BUSINESS DAYS for completion of your request. 
1. FAX: is our PREFERRED and the most efficient method to communicate requests to pharmacies. (Not for stimulant medications.)

        Enter your Pharmacy's  FAX number :

(Pharmacy telephone, REQUIRED for ePrescribe, Dr's Coffman, Kirsch, Nitsche, Perez, R. Slayden):

or 
2. MAIL: Enter YOUR address (not pharmacy's) below to have your RX mailed to you. 
                         or 
3. Pick-UpPick up NOT available until further notice

We do not contact you to notify you if your Rx has been sent. 
Allow three business days for fulfillment unless expedited (see below.) 
If you are picking up a prescription, call (770) 393-1880 ext 0 to verify that your prescription is ready before coming to pick it up. 
Atlanta Area Family Psychiatry Clinic, P.C.
7000 Peachtree Dunwoody Rd, Building 16 Suite 100 ~ Sandy Springs, GA 30328
Telephone (770) 393-1880 ~ Facsimile (770) 393-1885
©  R. Slayden, M.D.
Atlanta Area Family Psychiatry Clinic, P.C.
Psychiatric and psychotherapeutic care for adults, children, adolescents and families 
since 1977
 Email prescription refill request
Please allow THREE FULL BUSINESS DAYS for completion of your request. 
Also note that some mail-in pharmacies take up to two weeks to fill your prescription. 

Drs Coffman, Kirsch, Nitsche, Perez, & R. Slayden ePrescribe. All their prescriptions are transmitted directly to your pharmacy.
You must provide your pharmacy telephone number for ALL of their prescriptions.

Amphetamine salts, Concerta, Daytrana, Dexedrine, Dextrostat, Focalin (XR), Metadate, Methylin, methylphenadate, Ritalin, Vyvanse and others are mail out or ePrescribe only. 

 To send: press the "Submit" button at bottom of page.
Fill in all appropriate fields, 
( * = required field 
Use your mouse or "Tab" to go to next box or "Shift"+"Tab" to go back.
Pay expedited fee here $25, also be sure to also click "Submit" below.
Double click here to add textI will pick my Rx up at AAFPC's office  
  (M-Th 9 am - 5:00 pm; Fridays by NOON) (No/Yes)