Dear Client,


Please use the form below to update your current list of prescribed medications. Please include the name, dose, and frequency of each medication.


In order to assist you during the annual enrollment period from October 15th-December 7th, we ask that you use the form below to grant us access to your online profile with Unless you request otherwise, access to your online profile will only be used to verify eligibility and research medications on your behalf. 

Client privacy is very important to us. All sensitive data is encrypted for your safety and client information is kept secure in accordance with the Federal Health Insurance Portability and Accountability Act (HIPPAA).