Northern Virginia Pediatric Associates, P.C.
107 North Virginia Ave, Falls Church, VA 22046
24 Hour Phone #: (703) 532-4446 | Fax #: (703) 532-8426

By Appointment Only
Monday - Friday: 8:00 am - 7:00 pm
Saturday: 8:00 am - 1:00 pm
Sunday & Holidays: 9:00 am - 12 pm

Copyright © 2019 Northern Virginia Pediatric Associates, P.C. All Rights Reserved.

Thank you for using our online forms. Please note that the collected data from online submitted forms will be deleted within 48 business hours by one of our team members for security purposes.

Prescription Refill and Order Form

Please fill out the form completely and accurately. Five working days may be needed for prescriptions to be completed. Outside a visit, a fee of $20.00 will be due. Upon your request, and if available, refills may be expedited at an additional fee.

Patients needing ADHD or behavioral disorders medications must be seen every month until the medication and dose have been established. After that, patients should be seen every 3 months and medications will be prescribed for up to 90 days. Patients also need to be seen if there is a change of dose or a change of medication. The prescription cannot be called to your pharmacist.

Please, use one form for each prescription.