Immunotherapy Refill Request

    IMMUNOTHERAPY REFILL REQUEST

Please allow refill requests to take up to 7-10 business days to refill upon receipt of this form. For all sublingual immunotherapy refills (allergy drops), payment is due prior to refill. Copies of patients schedules should be attached with all refill requests, otherwise, no refills will be given.

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Please do not submit any Protected Health Information (PHI).

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