Get First Steps Enrollment Form - Apthorp Pharmacy

Filling out the First Steps Enrollment Form for Apthorp Pharmacy online is a straightforward process that ensures you provide all necessary information for your treatment. This guide will take you through each section of the form with step-by-step instructions to help you successfully complete the enrollment process.

Follow the steps to complete the form online with ease.

1. Click ‘Get Form’ button to obtain the enrollment form and open it in your preferred document editor.
2. Begin by filling out the patient information section. Provide your last name, first name, and date of birth. Ensure that the information is spelled correctly and formatted properly.
3. Enter your gender, home phone, and mobile phone numbers in the designated fields.
4. Complete your street address, including city, state, and zip code. Include a clearly printed email address where you can be contacted.
5. Indicate your preferred method of contact by selecting the appropriate option from the provided choices.
6. Provide your healthcare provider's email, ensuring that it is printed clearly.
7. Fill out the pharmacy email section to ensure accurate communication regarding your enrollment.
8. In the treatment section, specify whether you are currently undergoing treatment with a fertility specialist. If 'yes,' please provide the physician's name.
9. Indicate whether you have ever received products through DesignRx First Steps. If yes, select the products you have been prescribed.
10. Prepare your income verification documents to fax or mail to DesignRx First Steps. You may need to provide income documents such as a 1040 Form, W2, or Social Security Award Letter.
11. Indicate how many people live in your household in the designated field.
12. Review all sections carefully to ensure that all information is complete and accurate.
13. Sign and date the form in the patient signature section, certifying that you agree to the terms and conditions.
14. Save your changes, then download, print, or share the form as required.

Complete your enrollment form online today to ensure timely processing and support for your treatment.