Get Primemail New Prescription Fax Order Form

Filling out the PrimeMail New Prescription Fax Order Form online can streamline the process of obtaining your prescriptions. This guide provides clear instructions for each section of the form, ensuring you understand what is required to complete it successfully.

Follow the steps to accurately complete your prescription order form.

1. Click ‘Get Form’ button to obtain the form and open it in the specified editor.
2. Complete the prescription section by filling in the prescriber’s details, including their name, fax number, and any necessary patient information. Ensure that all information is entered clearly, using black ink if completing it manually.
3. Ask your prescriber to complete their section of the form. The prescriber must fax the completed form from their office or directly mail it to: PrimeMail, P.O. Box 650041, Dallas, TX 75265-0041.
4. In the patient section, provide your personal details including first name, middle initial, last name, date of birth, and contact information. Ensure that the shipping address is not a P.O. Box.
5. Indicate any drug allergies and health conditions by checking the appropriate boxes. It is essential to provide accurate medical history to ensure your safety.
6. Complete the payment section by entering your credit card information, including the card number, expiration date, and cardholder’s signature. Verify that all financial details are correct before submission.
7. Review the entire form for accuracy. Once all sections are filled out correctly, save changes if working online, or print the form if required. Finally, ensure it is either faxed or mailed as specified.

Complete your PrimeMail New Prescription Fax Order Form online today to ensure timely processing of your prescription.