Membership Form

Membership Form
Standard/ Individual MembershipFamily Membership
STANDARD/ INDIVIDUAL MEMBERSHIP • $50/year This membership is best for individuals looking to access our pricing model's convenient monthly fills, with minimal need for pharmacist consultation or review.

FAMILY MEMBERSHIP • $150/year This membership is best for families looking to take advantage of our pricing model, who would like the convenience of single household deliveries, or pet medication savings.
SPECIAL PHARMACY SERVICES
Medication Synchronization (Med-Sync): Refill all prescriptions on the same day each month90-Day Supply: Fill eligible medications in 90-day quantities for convenienceHome Delivery: Get medications delivered to your home (Ask staff for details on availability and fees)Automatic Refills: Have medications automatically refilled before you run outImmunizations: Receive routine immunizations at the pharmacyPoint of Care Testing Services: Pharmacy-provided testing services for common community acquired infections such as flu, strep, or other metabolic testingSmoking Cessation Services: Receive one-on-one or group consultations with a pharmacist on available aids to quit smokingMedication Therapy Management (MTM): One-on-one pharmacist consultation to optimize therapy
PAYMENT INFORMATION
Credit/Debit CardACH/Bank TransferHSA/FSA CardOther:Other
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*By providing my phone number, I consent to receive marketing and promotional text messages from Compass Core Pharmacy at the phone number provided. I understand that these messages may include special offers, promotions, product updates, and other relevant information. I acknowledge that: (a) message frequency may vary; (b) standard message and data rates may apply; and (c) my consent is not a condition of purchase. I can opt out at any time by replying “STOP” to any message received. For more information on how we handle your data, please review our Privacy Policy in store or at compasscorerx.com.
CONSENT & SIGNATURE
By signing below, I confirm that the information provided is accurate. I authorize Compass Core Pharmacy to obtain my prescription history, manage my medications, and provide requested pharmacy services.
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Select Membership

Standard Membership

This membership is best for individuals looking to access our pricing model’s convenient monthly fills, with minimal need for pharmacist consultation or review.

$100 for each year

Individual Plus One Membership

This membership is best for couples looking to access our pricing model's convenient monthly fills, with minimal need for pharmacist consultation or review

$150 for each year

Premium Plus Membership

This membership is best for individuals managing multiple medications or chronic conditions who need frequent pharmacist support.

$250 for each year

Family Membership

This membership is best for families looking to take advantage of our pricing model, who would like the convenience of single household deliveries, or pet medication savings.

$250 for each year

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Membership Form

SPECIAL PHARMACY SERVICES

PAYMENT INFORMATION

CONSENT & SIGNATURE