if you have questions about your ... - ut health east texas · if you have questions about your...

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If you have questions about your healthcare, please call your providers office and our staff will notify your provider care: and we will return your call within 24 working hours. request routine refills 72 hours in advance of needing the medicine. Simply call your pharmacy and ask them to fax a refill request. We’ll take care of the rest. Your pharmacy should be able to process and provide your refill with no problem (Due to narcotics control regulations, pain medications and all controlled substances may only be refilled during regular business hours. Whenever possible, if you are unable to make your appointment, please call our office and we will be glad to Print Name Signature DOB Date

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Page 1: If you have questions about your ... - UT Health East Texas · If you have questions about your healthcare, please call your providers office and our staff will notify your provider

If you have questions about your healthcare, please call your providers office and our staff will notify your provider

care: and we will return your call within 24 working hours.

request routine refills 72 hours in advance of needing the medicine. Simply call your pharmacy and ask themto fax a refill request. We’ll take care of the rest. Your pharmacy should be able to process and provide your

refill with no problem (Due to narcotics control regulations, pain medications and all controlled substancesmay only be refilled during regular business hours.

Whenever possible, if you are unable to make your appointment, please call our office and we will be glad to

Print Name

Signature

DOB

Date

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