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