ALEXANDER ROAD ASSOCIATES

Current Patients

Refills

Forms

Telehealth

Patient Portal

Request a Prescription Refill

Required fields are marked with *

Refilling your prescription has never been easier. We do NOT accept refill requests from pharmacies. We would like the patient to complete the form below to submit your prescription refill(s) online. Please allow three business days for completion of your request. The prescription refill form is the quickest way to notify your physician of a request as this form is sent directly to your physician’s email address.

Choose Provider:
Dr. Kurz, Dr. Mian, Dr. Myles, Dr. Li

Choose Provider: Dr. Kurz, Dr. Mian, Dr. Myles, Dr. Li

Please enter your information.

Pharmacy Information
(all info must be included)
Prescription Refill
Choose Provider

Forms

ARA Adult Psychiatry
Intake Packet

1

ARA Child Psychiatry
Intake Packet

2

ARA Release of
Information Form

3

ARA Adult Therapy
Intake Packet

4

ARA Child Therapy
Intake Packet

5

Credit Card
Authorization

6

ARA Patient
Privacy Policy

7

Alexander Road Associates offers a patient portal to provide you with information about your appointments, view doctor’s calendar to schedule own appointments, manage and make payments, receive diagnostic testing, and access invoices.