• New patient form

    Step 1 of 6: Why you're here. About 5 minutes. Required: the reason for your visit, name, date of birth, mobile and, on the last step, your pharmacy.
  • What brings you to OnPoint?*
  •  -

  • Good idea. We set up your profile now, so when a prescription arrives we can fill it without a long first call.

  • Not for emergencies. If you are out of a medication today, call your pharmacy. For a medical emergency, call 911.

  • About you

    Step 2 of 6. Required: legal name, date of birth and mobile phone.
  • Date of birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • How should we reach you about this form?
  • Can someone else talk with us about your care?

  • Who can talk with us about your care

  • Format: (000) 000-0000.
  • Permissions

  • Prescription insurance

    Step 3 of 6. A photo of the front and back of your card is enough. No card handy? Choose "I'll provide this later."
  • How do you want to share your insurance?
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Do you have another prescription plan or a copay card?

  • Second plan or copay card

    Type the details or upload a photo of the card.
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof

  • Medications and allergies

    Step 4 of 6. Include everything you take, even medications filled at another pharmacy.
  • Do you have any allergies to medications, foods or latex?
  • Upload a File
    Drag and drop files here
    Choose a file
    Cancelof
  • Do you take any over-the-counter medicines, vitamins or supplements?
  • Which ones?
  • Would you like us to transfer your medications to OnPoint?

  • Your doctors

    Step 5 of 6. Optional, but it helps us reach them for refills and approvals.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Health conditions

    Helps the pharmacist check your medications. Optional.
  • Do you have any ongoing health conditions?
  • Which ones?

  • How you want your pharmacy to work

    Step 6 of 6: Preferences and review.
  • Getting your medication
  • Helpful extras
  • Automatic refills
  • Automatic delivery

  • Review and send

  • Sending to: {store}

    Wrong pharmacy? Change it right below. You don't need to go back.

    Your answers

    Reason {reason}
    Name {name}
    Date of birth {dob}
    Mobile {phone}
    Email {email}
    Address {address}
    Contact by {reach}
    Insurance {i1method}
    Allergies {allergyStatus} {allergies}
    Other medicines {otc_any}
    Health conditions {cond_any}
    Pickup or delivery {getting}
    Automatic refills {autorefill}
    Automatic delivery {autodeliver}

    Blank means you skipped it. That is fine. To change anything other than the pharmacy, use Back.

    What happens next

    • The pharmacy team at that store reviews your form.
    • They contact you the way you chose. If anything is missing, they ask then.
    • Need a medication today? Call the store as well so they can start right away.
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: