Get Walmart Mailorderform Prescription Order Form.doc

Filling out the Walmart MailOrderForm Prescription Order Form online is a straightforward process that ensures your medication needs are met promptly. This guide will walk you through each section of the form to help you complete it accurately.

Follow the steps to complete the prescription order form online.

1. Click ‘Get Form’ button to obtain the form and open it in your online editing tool.
2. Begin by entering the patient information. Complete fields for the name (last, first, middle), city, state, home phone, alternate phone (if applicable), date of birth, email address, allergies, health conditions, and current medications.
3. If you are a new customer or if your information has changed, fill out the insurance or prescription plan information. Include your Insurance ID number, group number, and the name of the insured or policy holder, along with their relationship to the insured.
4. Provide healthcare provider information by entering the physician's name and phone number.
5. In the payment information section, note that credit card details are not requested via fax or mail. Indicate your payment method by allowing time for form processing and be ready to call for payment.
6. Indicate prescription details by checking 'refill', 'new prescription', or 'transfer'. Enter the pharmacy name and phone number, along with the relevant Rx numbers for refills or medication details for new prescriptions and transfers.
7. Finally, review your information for accuracy and provide your signature and the date to complete the form. Once you are satisfied, save your changes, download, print, or share the completed form as needed.

Complete and submit your documents online to ensure a smooth prescription process.