1497 Chain Bridge Road
Building 1497 Suite 105
McLean, Virginia 22101
Tel: 703-749-3003
Fax: 703-749-3004
Office Hours:
Monday - Friday
8:00 am - 6:00pm
Rx Authorization and Addition Forms
School Rx Authorization
Medication Authorization / Fairfax County Public Schools
If you need Dr. Bir to fill out an authorization form for school please fill out the Fairfax County Public Schools Medication Authorization form to the best of your ability and fax (703-749-3004) the form to the office with instructions to whom you would like the form faxed. Please leave your contact number(s) and the contact name, phone number, and fax number of the designated recipient.
Rx Request
To request a prescription refill, please fill out the Rx Request' form and fax it to 703-749-3004. Please allow 48 hours for prescription request.
Please note, that 'controlled' medications (i.e. stimulant medications for ADHD) cannot be called in to a pharmacy. These medications can be picked up at the office.
If you have not seen Dr. Bir within the last 3 months you need to make an appointment.
If you need Dr. Bir to fill out an authorization form for school please fill out the Fairfax County Public Schools Medication Authorization form to the best of your ability and fax (703-749-3004) the form to the office with instructions to whom you would like the form faxed. Please leave your contact number(s) and the contact name, phone number, and fax number of the designated recipient.
Additional Forms
Authorization for Release of Information - Adult
Authorization for Release of Information - Child
Consent for Treatment with Medication - Adult
Consent for Treatment with Medication - Child
School RX Authorization
If you need Dr. Bir to fill out an authorization form for school please fill out the Fairfax County Public Schools Medication Authorization form to the best of your ability and fax (703-749-3004) the form to the office with instructions to whom you would like the form faxed. Please leave your contact number(s) and the contact name, phone number, and fax number of the designated recipient.