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.
- New Prescription Mail-In Form (PDF)
- New Prescription Mail-In Form (online)
- Prescription Transfer Form (PDF)
- Prescription Transfer Form (online)
- Request for Information Update
- Prescription Reimbursement Claim Form
- OTC At-Home COVID-19 Test Kit Reimbursement 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.