Chi Shum, M.D. Dr. Chi Shum

Prescription Refill Request

Effective starting November 2, 2017, CVS pharmacies will no longer fill any controlled medications. If you need controlled medications, please provide us a non-CVS pharmacy phone number.

If you are an established patient, please provide the following information.
If you are a new patient, please contact my office for an appointment.

Patient Name :
Date of Birth :    
Name of Medication :
Dosage of Medication :
Frequency of Medication :
Drug Allergy :
Pharmacy Phone Number :
Patient Telephone :
Patient Email :
 
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