Patient Registration

  • Patient Information

    Please upload a copy of the patient's driver license or type in the information below.

  • Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 256 MB.
  • Insurance Information

    Please upload a picture of your insurance card or type in the information into the form.

  • Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 256 MB.
  • Accepted file types: jpg, jpeg, png, gif, pdf, Max. file size: 256 MB.
  • Enter information manually

  • Health History

  • The pharmacy will reach out to you to confirm any final copy associated with your prescription and pickup/delivery confirmation. Please be available for our phone call.