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Member Forms

Complete and Return

From time to time, you may be asked to complete and return specific forms to Serve You Rx. Click the links to view commonly used forms. If the form you are looking for is not listed, please call 800-759-3203.

Member Forms

  • Prescription Reimbursement Claim Form
  • Authorization to Use and Disclose PHI
  • Medical History Form

Note: All forms are in .pdf (Acrobat) format. You can download the latest version of the Acrobat Reader software on Adobe's website for free.

About Serve You Rx

We have been an independent, privately held, full-service PBM since 1987. Built on a reputation for service excellence, we have expanded our capabilities from the ground up with our hardworking team and proven process for managing drug spend with innovative and cost-effective benefit solutions.

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About us

10201 W Innovation Dr #600, Milwaukee, WI 53226

About Serve You Rx

We have been an independent, privately held, full-service PBM since 1987. Built on a reputation for service excellence, we have expanded our capabilities from the ground up with our hardworking team and proven process for managing drug spend with innovative and cost-effective benefit solutions.

About Us

Company

About Us

careers

Contact Us

Partners

What We Do

Who We Are

Let's meet

Providers

Provider Forms

Drug Lists

Members

Pharmacies

Member Portal

FAQs

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