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RX Refill Request
Disclaimer

By clicking on the 'I Agree' button below, you acknowledge and accept that:
Pasadena Center For Asthma & Lung Disorders is providing the means to request certain routine services for your convenience via this on-line link. With few exceptions, using this service will ensure faster response from Pasadena Center For Asthma & Lung Disorders, and will prevent unnecessary calls to you to clarify what you need. So that this may be a good experience for all concerned, there are rules to follow. To proceed further, you must agree to the following rules:
 
  1. I agree to read the instructions on each request form that I use. In particular, I will carefully review the purpose and limitations statements on each form that I use.
     
  2. I understand and agree that the request forms are NOT to be used as a means of dialog (two-way contact) with Pasadena Center For Asthma & Lung Disorders provider's or office, but merely to convey my request for the specific service, except as specifically noted on that form. If I need to speak with the physician or nurse, I will call the office.
     
  3. I understand that the process of requesting services via these forms have a required waiting period or built-in delay or time allowance for Pasadena Center For Asthma & Lung Disorders response. If I need services more quickly than the wait interval shown on each request form, I will call the office. If it is an urgent matter or an emergency, I agree to seek care at the most available medical facility, including a hospital emergency room or call 911, as appropriate.
     
  4. I agree that I will not use these forms to request services that need immediate attention or where my health may be jeopardized by a delay.
 
Having read and understanding all of the above, I agree to use the forms for the stated purposes as shown on each form. By clicking the "I Agree" button, below, I affirm my intention to abide by the above rules.

I AGREE BACK

 


                               
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