Do not use this form for urgent or emergency concerns.
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Prior treatment or pharmacy records may be required before certain medications can be prescribed.
For patients located in New York or New Jersey, this practice does not prescribe controlled substances by telehealth.
If yes, please briefly describe whether you are seeking a transfer of care, second opinion, or additional treatment.
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For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.