Insurance Form Support

Insurance form support
We can help you complete the special authorization form requested by your insurance so you can apply for coverage.

Before we can help, you’ll need to request the forms from your insurance provider and fill in your info.

Once that’s done:
1. Upload the partially completed forms here.
2. Our healthcare team will fill out the remainder and send it back to you.
3. Submit the completed form to your insurance provider.
Important notes:
- You are responsible for requesting the correct form from your insurance provider.
- Please do not submit the same form request multiple times, as it my cause delays.
- By submitting your insurance request, you acknowledge that a third party will store the information provided. If you prefer, you may also submit your form request to us by clicking on the chat bubble at the bottom right corner of your account or through our Contact Us page.

Before uploading your form, we need to ask you a few of questions.
What is the email address associated with your Felix account?*

What medication are you seeking coverage for?*

Is this your first special authorization request with this insurer?*

YesNo, it’s a subsequent request

Would you like to place your prescription on hold?*

Yes, place my next fill on hold.No, bill cash and send my next fill as soon as possible.
Please note: we cannot cancel or refund medications already being processed. If you selected an external pharmacy, please contact them directly.

One last step
Before uploading your forms, please acknowledge you understand and agree to the terms below:*

A $35 fee will be charged to your credit card on file for each insurance form submitted.Form completion is not guaranteed and is at the discretion of your healthcare practitioner.My medical information in my profile is up-to-date.

Upload your insurance form
A few important notes:
- If you don't have these forms yet, request them from your insurance provider.
- Please ensure that you fill out, sign and date the patient section before uploading.
- Leave the medical and medication sections blank - your practitioner will fill these out.
- Upload your forms as a PDF.
File Upload*

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You’re all set!
Thanks for submitting your form. We’ll get back to you in 3-5 business days.

If you have any questions, get in touch with Felix support by clicking on the chat bubble at the bottom right corner of your Felix account or through our Contact Us page.
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