7400 Fannin | Suite 910
Houston, Texas 77054
Phone: 713.790.0099
Toll: 866.790.0095 
Fax: 713.790.0527
E-mail:  
info@rosenfeldmd.com

Prescriptions received during normal business hours will be called in to your pharmacy or mailed directly to you by 12:00 noon of the following business day. For fastest handling of your prescription please FAX it to 713-790-0527.

Instructions
Online Refills: Fill out this form and press Email Form.
Faxed Refills: Fill out this form, print it, and fax it to 713-790-0527.
    Your Information
Name:
Date of Birth:
Phone:
E-mail:
   
    Pharmacy Information
Phone:
   
    Prescription Refill Information
Medication Name:
Dosage:
Frequency Used:
   
    Phone In or Mail Prescription
Select One: Phone in my prescription
  Mail me my prescription to fill at a local pharmacy
  Mail me my prescription for a mail order pharmacy
   
    Special Instructions
 
     
 
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