Printable Prescription Form

We are in network with the following insurance companies: All Blue Cross and Blue Shield plans, UHC, UMR, Aetna, and Freedom Network. If your insurance is not listed please call to verify coverage.

1. Click on PDF below and print

2. Fill out the form

3. Bring the form to your next appointment to have signed

4. Call us and we will verify your benefits

5 Bring your prescription in for same day pick up