​​**​It is your responsibility to submit these forms in a timely manner to your insurance carrier for reimbursement! Reimbursement rates are determined by your insurane carrier, and may vary by plan**


​Please Fill in the  appropriate PRESCRIPTION MAIL ORDER form and

bring to your appointment!!



CONTACT:

(860)823-0245 or

amylaneaprnllc@gmail.com

Copyright
© 2013 | Amy Lane APRN

Amy Lane APRN