Patient & Facility Forms

Everything you need — in one place.

Submit a prescription refill, transfer your meds from another pharmacy, enroll as a new patient, or request a long-term care walk-through. Every form is HIPAA-compliant.

Patient Forms

Prescription Refill Request

Request a refill on an existing prescription. Most refills are ready within 30 minutes.

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Transfer a Prescription

Move your prescriptions from another pharmacy to Auburn Pharmacy. We'll handle the call and paperwork — you don't have to.

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New Patient Enrollment

Set up your patient profile before your first visit. The more we know up front, the smoother your first prescription will be.

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Vaccine Consent

Required before any immunization. Please complete this form before your appointment so we can pre-screen and have everything ready.

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Medication Synchronization Enrollment

Align all your prescriptions to one convenient pickup date each month.

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Facility Forms

Long-Term Care Facility Inquiry

For assisted living residences, group homes, skilled nursing facilities, and hospice. Tell us about your operation and we'll schedule a walk-through.

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Billing

Update Payment on File

Update the credit or debit card we keep on file for co-pays and home-delivery orders. For your security, we never collect full card numbers through this form — we'll call you to take card details on a secure line.

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HIPAA & Privacy Notice

Auburn Pharmacy & Home Health Care complies with the Health Insurance Portability and Accountability Act (HIPAA). The information you submit through this form is Protected Health Information (PHI) and will be used solely to fulfill your request, coordinate with your prescriber, and process insurance — never sold or shared with marketers.

This online form is not a secure method of communication; please do not include credit card numbers, social security numbers, or other highly sensitive data. By submitting, you authorize Auburn Pharmacy to use your information consistent with our Notice of Privacy Practices, available on request.

For medical emergencies, call 911. For urgent prescription needs, call us at (508) 832-6511.