New Patients: We ask that you print and complete the "Intake" form to bring with you to your appointment. If you are unable to print or complete these forms prior to your appointment please arrive 10-15 minutes early to complete them in our office.
Click on the link(s) below to download & print forms:
Forms for Dr. Suzanne Veilleux's patients only
Click on the link below to download forms from Dr. Veilleux's personal website:
Prescription refill requests
should be handled at your appointment with your physician. Your provider will prescribe enough
medication to last until the next recommended appointment. Prescriptions for controlled substances will
only be provided during appointments.
While being prescribed a controlled substance, you will need to be seen
monthly for the first few months or as directed by your provider, no exceptions. If a prescription refill is necessary outside
of a normal office visit, please contact your pharmacy and they will fax over a
refill request to your provider. (Please note that your physician may require
you to make an appointment prior to getting any refills.) Please allow a
minimum of 72 business hours for all medication refill requests. We encourage you to request
refills, a few days in advance when you will need them and to anticipate your
need for refills before weekends and holidays.
**There will be a $25 charge for: same day refill requests, requests
less than 72 hour notice, and/or refills given outside of business hours.
For medication refills, please call your pharmacy and have them fax your medication request to our office, OR you can use the form below. You can also directly email us at: Lpameds@gmail.com.
Please allow at least 48-72 hours for your refill request to be completed.
Please provide the following information in the comment section:
Prescribing Physician (Dr. Joseph Walters or Dr. Richard Ford)
Patient Name and Date of Birth
Pharmacy and Phone #
Medication and Dose (ex: prozac 20mg 1x morning, etc...)