Prescription Drug Info


In order to construct an accurate cost analysis, we will need your complete and correct drug information. For example, it is important to indicate the name of the drug that you are taking, and whether you are taking a BRAND or GENERIC version. Please note, over-the-counter medications, vitamins, and supplements are not covered by prescription drug plans and therefore are not required on this form.

Please complete and email your prescription drug information at least 2-5 days prior to your consultation; doing so will shorten the amount of time you spend on the consultation call. 

  1. Download a copy of the Prescription Drug information form
  2. Fill out the form as needed
  3. Save a copy of the completed form, with your healthcare provider information included, to your computer 
  4. Email the form back to us at Remember, anything you send will be transmitted securely and will never be shared.
  5. Your information will be pre-loaded and available for your Benefits Counselor prior to your consultation.

Prescription Drug Information Form

Providing information regarding the prescription drugs you regularly take will help your Benefits Counselor.

Click below to download and complete the worksheet. You will need to save a copy of it to your computer before you email it to us; your information will not be automatically saved, so if you close the form before saving your information, it will be lost and you will need to start again.  

Download the form