Phone: 316-491-6428 8200 W Central Ave. Ste. 5, Wichita, KS 67212
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REFILL PRESCRIPTIONS
Patient Forms
Patient Transfer Form
Want to make a change to our pharmacy? Fill out this form and return or fax to the pharmacy and we will have all your prescriptions transferred over!
Notice of Privacy Practice
We take our patients privacy very seriously! Read about our privacy policy and ask our staff if you have any questions.
Child Resistant Waiver
Do want your medications in NON child-proof packaging? Fill out this waiver and bring it into the pharmacy.
Medicare Drug Coverage Rights
Medicare patients can click here to learn about your rights as medicare member!
Vaccine Administration Form
Interested in receiving a vaccination? Fill out this form and bring it with you to the pharmacy!
MedSync Enrollment Form
Interested in signing up for our MedSync Program? Fill out this form and bring it into the pharmacy to begin your enrollment!
Collaborative Practice Acknowledgment
Travel Health Form
Traveling out of the country? Fill out the first 2 pages of this form and bring it into the pharmacy to receive your personalized travel health report!
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