Get Mail-in Form - My Doctor Online - Kaiser Permanente - Mydoctor Kaiserpermanente

This guide provides a step-by-step approach to accurately completing the Mail-in Form for My Doctor Online at Kaiser Permanente. Understanding the components of the form will help ensure that your prescription refill requests are processed efficiently and effectively.

Follow the steps to complete your mail-in prescription refill form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering your personal details in the designated fields. This includes your name (last, first, and middle initial), address (including city, state, and ZIP code), and telephone numbers (day and evening). Ensure all entries are accurate to avoid any delays.
3. Provide your Kaiser Permanente account number, if applicable. This helps in tracking your request and ensuring it is linked to your profile.
4. In the payment section, indicate your chosen payment method by checking the appropriate box for debit/ATM/check card or credit card (Visa, MasterCard, or American Express). Enter the cardholder's name, card number, expiration date, and the amount enclosed. Note that orders must be paid in advance.
5. Complete the shipping information section. This will confirm where your prescription will be sent once it is processed. Ensure your address matches the one provided earlier.
6. Sign the form where indicated, confirming that all provided information is correct and that you agree to the terms of the order.
7. Once the form is complete, you can save your changes, download a copy for your records, and print the form. Finally, mail the completed form to the address specified within the document.

To ensure a seamless and convenient ordering process, start filling out your Mail-in Form online today.