Rx Authorization and Addition Forms

School Rx Authorization 

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Medication Authorization / Fairfax County Public Schools

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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.

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Rx Request

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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.

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Additional Forms

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RX Request    

Authorization for Release of Information - Adult

Authorization for Release of Information - Child

Consent for Treatment with Medication - Adult

Consent for Treatment with Medication - Child

Billing Information

Contact Information

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.

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