Follow the steps to complete the OptumRX Mail-Order Form effectively.

1. Press the ‘Get Form’ button to acquire the form and open it for completion.
2. Begin by entering the primary member ID number and plan name at the top of the form. If applicable, include the secondary member ID number and corresponding plan name.
3. Fill in your personal information, including your first name, last name, delivery address, apartment number (if applicable), city, state, date of birth, and gender.
4. Provide your contact information by entering your phone number and email address. Also, include your physician’s name and their phone number for reference.
5. If you are a new customer or have experienced changes in your health history or allergies, include relevant notes in the designated section to ensure a thorough review of your medication request.
6. Indicate your preference regarding generic substitutions. If you need brand-name medications only, specify them in the space provided, noting that they may incur higher costs.
7. If you wish to keep certain prescriptions on file to be shipped later, list those medications in the area marked ‘Do not ship.’
8. Proceed to the payment and shipping information section. Ensure you do not send cash. Choose your delivery option and note any required shipping charges, specifying if you want overnight shipping.
9. Select your payment method by either enclosing a signed check or providing your credit card details, including the card number and expiration date.
10. After reviewing your completed form for accuracy, sign and date it. This authorizes the necessary transactions and provides consent to maintain your credit card information for future payments.
11. Save your changes, download a copy for your records, and print the form if necessary. You may also share the completed form as needed.

Complete your OptumRX Mail-Order Form online today for a seamless prescription management experience.