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:

First: Slect Rx refill fee, outside of appointment, $25 (allow 3 FULL BUSSINESS DAYS)
or
Expedited handling, rapid service, if received before NOON, request will be filled the same business day, requests received after 12 NOON will be filled by NOON the next business day, $45 fee
 SELECT "Outside of appointment" or "Expedited" here:

NOTE These fees are one time for all Rx's requested this day, not for each Rx.
You must ALSO click "Submit" below after payment to complete this request. 
If you are submitting a 2nd or 3rd sheet you do not need to pay additional fees.
Third: You MUST click "Submit" AFTER completing payment to finalize your request to AAFPC
Your request will NOT be completed by making payment alone:

 3rd and last, click SUBMIT >

Requests are handled by secretary. No Rx's are sent if office is closed.

ADHD Controlled Medication Rx's
All stimulants; Adderall, amphetamine salts, Concerta, Daytrana, Dexedrine, Dextrostat, Focalin (+XR), Metadate, Methylin, methylphenidate, Ritalin, Vyvanse and others
 are ePrescribe or (Mail to you, Drs Ashley and Waugh).
Note that a few mail-in pharmacies may take up to two weeks to fill your prescription. 


Drs Kirsch, Iwanicki, Nitsche, Perez, Elizabeth Slayden and Robert Slayden are ePrescribing physicians and REQUIRE that you submit your PHARMACY TELEPHONE NUMBERand ZIP code so that your Rx may be submitted directly to your pharmacy electronically including controlled drugs.

1. For Drs Ashley and Waugh also need Pharmacy telephone to locate your pharmacy in our records (Not for stimulant medications.)

                   Enter your Pharmacy's Name & ZIP:

                     Enter your Pharmacy's Telephone:


Is this a NEW pharmacy (or different form last Pharmacy used?
                                             or
2. US Postal MAIL: Enter YOUR address (not pharmacy's) below to have your RX mailed to you. (Dr. Ashley & Waugh controlled drugs.)
                         or 
3. Pick-UpPick up NOT available until further notice

Please CALL your pharmacy to confirm your Rx has been filled before calling us (many pharmacies are inefficient in sending filled notifications.) 
We do not contact you to notify you if your Rx has been sent. 
Allow three business days for fulfillment unless expedited (see below.)
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
Rx refill, select service below, PayPal account NOT required
Please enter patient's name.
 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 Kirsch, Iwanicki, Nitsche, Perez, E. Slayden & R. Slayden ePrescribe. All their prescriptions are transmitted directly to your pharmacy.
You must provide your pharmacy telephone number for ALL of their prescriptions.


Fill in all appropriate fields, ( * = required field ) 
 To send: after payment, press the "Submit" button at bottom of page.

Second: Pay refill fee here $25, Expedited $45 
You must click "Submit" below after payment is made to complete refill request. 

NOTE: PayPal payment confirmation is NOT submission confirmation you MUST return to this page to click "Submit". 

The PATIENT's NAME is REQUIRED 

NOTE: Effective 1/1/2022
Any Rx filled outside of an appointment will be charged $25 or 
$45 for expedited requests.

Your email address : *