Osteoporosis Specialty Pharmacy Enrollment Adobe PDF Interactive Form
The Osteoporosis Enrollment Form is one of the most important forms for pharmacies to have available.
Pharmacies fill out the header of the form.
After entering the pharmacy information, saving the form will allow pharmacies to easily send copies to prescribers.
Once received, prescribers enter the Patient Information and Prescriber Information sections available at the top of the form.
Afterwards, prescribers can easily check off the medications and sign the form.
The Signature field allows for manual or electronic entry at the bottom of the form.
Additionally, this form is a great tool to use as marketing and advertising to prescribers.
Also, prescribers are more likely to remember the pharmacy when prescribing the related medications.
The following drugs are listed on this enrollment form. Strengths vary per medication, but an area is available to manually enter or electronically input strength, Sig, Qty, & Refills for each listed drug.
- Forteo 600ug
- 5mm Needles 31 gauge
- 6mm Needles 31 gauge
- 8mm Needles 31 gauge
- Prolia 60mg
- Reclast 5mg
- Tymlos 3120 mcg
- 5mm 31G Pen Needles
- 6mm 31G Pen Needles
- 8mm 31G Pen Needles
Alternatively, Contact us by email for more information or to customize the enrollment form for a specific pharmacy.
The form is available an interactive Adobe PDF.