Express scripts fax form 2026

1. Click ‘Get Form’ to open the express scripts fax form in the editor.
2. Begin by filling out the 'Patient' section. Ensure you include your Member ID, First Name, Last Name, Address, Date of Birth, and Phone number.
3. Next, complete the 'Doctor/Prescriber' section. Fill in the Doctor's name, DEA number, Address, Phone number, and Fax number.
4. In the 'Patient Options' section, select any preferences such as non-child resistant caps or rush delivery if needed.
5. For prescriptions, provide details in the Rx section including Drug Name/Form/Strength and Quantity. Ensure your doctor signs where indicated.
6. Finally, review all entries for accuracy before submitting your completed form via fax or mail as per instructions provided.

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