Follow the steps to complete the intake form with ease.

1. Click the ‘Get Form’ button to access the New Client Intake Form and open it for editing.
2. In the 'Facility Information' section, provide details such as the facility code, received date, and delivery date if applicable.
3. Under 'Packaging', select the type of packaging that suits your needs by checking the appropriate box such as 'Bingo' or 'Multipack'.
4. Fill in your name, phone number, address, and email in the 'Contact Information' fields. Be sure to include any additional phone numbers where necessary.
5. In the 'Resident Medical Information' section, input the resident's last name, first name, date of birth, and any relevant chronic conditions or allergies.
6. Provide information for the resident's primary physician, including their name, phone number, and fax number. If there are any specialist physicians, attach a list.
7. For the 'Pharmacy Info', enter the previous pharmacy details and their contact number. If there are no known drug allergies, check the appropriate box.
8. In the 'Discharge Info' section, indicate where the resident is discharging from and answer any questions concerning their current medication supply.
9. Complete the 'Responsible Party / Payee Information' section by entering the responsible representative’s name, relationship, and billing address, checking any relevant boxes for decision-making authority.
10. Provide the 'Resident Insurance Information' by filling in the primary insurance company name and policy ID, along with attaching any required copies of the insurance cards.
11. Review the 'Pharmacy Services Provider Agreement', ensuring understanding of the terms before signing. Include the date and print the responsible party's name and relationship.
12. If applicable, enter credit card information for automatic payments, ensuring to complete all required fields, including card type and billing address.
13. Once all fields are completed accurately, save your changes, and you may choose to download, print, or share the completed form as needed.

Get started today by filling out the Ready Meds Pharmacy New Client Intake Form online to ensure timely and efficient pharmacy services.