The form below is a free service provided by the Rocky Mountain MS Center to allow you to contact our affiliates. The form securely converts your request to a fax then sends it to your Health Care Provider, ensuring that they are the only individual receiving your information. Please only use this service if you are a current patient or client of the listed Health Care Providers (HCP) below.
- Please fill out the online form with any routine request
- This would include:
- non-urgent medical questions
- appointment requests (please specify if you are a current or new patient)
- prescriptions refills (be sure to include the pharmacy name and phone number)
- You may expect a response within 48 hours, if you do not receive one please call your HCP
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