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South Shore Allergy & Asthma Specialists PC

851 Main Street
Suite 21
South Weymouth, MA 02190

(781) 331-1060

Prescription Request

Please submit your request for prescription renewals.  You must be an established patient and you must have been seen by one of our physicians within the past year. Please be assured that we do not share or sell personal information about you except when we have your permission.

First Name
M.I.
Last Name
Phone
Alternate Phone
Please provide the following information: medication, dosage, 30 or 90 day supply.
Bold = Required field
Date of Birth
Pharmacy Name & Phone Nymber
If your phone is blocked we can not call you back.
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