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Enrollment and updates

Home Services Pharmacy Enrollment and updates

Couldn’t find the form you needed on another page? Here are all of the forms you might need

New patient enrollment - Are you a new pharmacy patient? For your convenience, you can submit all your information here. When you're ready to have your first prescription filled, we will have your account set up and ready to go.

Access the New Patient Enrollment Form here »

If you have a question about any of these forms, call toll-free:

1-888-718-9044

Patient information updates - Are you an existing patient with a change of address, insurance or allergy information? Click on the appropriate link below. If you have a change of FSA or credit card information, please call our toll-free customer service directly at 1-888-718-9044.

Access the Patient Allergy Update Form here »

Access the Insurance Information Update Form here »

Access the Address and Contact Information Update Form here »

New and refill prescriptions

Have a new prescription? Need a refill? Want to change from pick-up to home deliver or be notified when your medications are ready? Just click on the appropriate link below and we will take care of it:

Access the Online Prescription Refill Form here »

Access the Auto-refill Prescription Form here »

Access the Prescription Transfer Form here »

Access the Email Notification / Text Alert Form here »

Paper prescriptions

Need to send us a paper prescription? Please print the appropriate form below and mail it to us along with your original paper prescription. We will process your order and deliver it to your address free of charge.

If you are new to our home delivery service, please select the New Patient Enrollment Form and mail it to our address as indicated on the form.

If you’re an existing patient, select the Existing Patient Update Form and mail it to our address as indicated on the form.

Access the printable New Patient Enrollment Form here »

Access the printable Existing Patient Update Form here »

Still can’t find what you need? If you have any questions, call customer service toll-free at 1-888-718-9044.