Follow the steps to complete your enrollment form online.

1. Click the ‘Get Form’ button to obtain the enrollment form and open it in your preferred document editor.
2. Begin by providing your personal information in the 'Patient Information' section. This includes your full name, date of birth, delivery address, social security number, city, state, zip code, and contact numbers. It is important to ensure all information is accurate and up to date.
3. Indicate your preferred method of contact by filling in the best contact number and email address. Specify whether you would like to receive delivery status updates.
4. In the 'Patient Insurance' section, select the type of insurance that applies to you by checking the appropriate box. If you have private insurance, Medicaid, or Medicare, please provide the related details and ensure to fax a copy of your insurance card along with the form.
5. Complete the 'Prescription(s)' section by indicating how your prescriptions will be submitted (e.g., sent with the form, sent separately, phoned in, or e-prescribed). If compliance packaging is needed, make sure to indicate this as well.
6. Attach any necessary prescriptions either below or on a separate sheet. Note that MedExpress can only accept faxed prescriptions from a prescriber’s office or original prescriptions from patients.
7. Once all sections of the form are completed, review your information for accuracy. Then you can save your changes, download the form, print it, or share it as required.

Take the time to complete your MedExpress Pharmacy Patient Enrollment Form online today to ensure a smooth pharmacy experience.