Costco pharmacy fax forms 2026

1. Click ‘Get Form’ to open the Costco Pharmacy Confidential Patient Information Form in the editor.
2. Begin by entering your personal information. Fill in your name, address (no PO Box), city, state, zip code, home phone, cell phone, email, and date of birth. Indicate your sex and whether you require safety caps for your medications.
3. Next, provide insurance coverage information. Indicate if you have insurance by selecting 'Yes' or 'No'. If applicable, answer questions regarding Medicare Part D, Part B, and Medicare Advantage.
4. In the Chronic Medical Conditions section, check all relevant conditions that apply to you. If you have other conditions not listed, write them in the provided space.
5. List any allergies to medications by checking the appropriate boxes or writing in any other allergies you may have. If you have no known allergies, select that option.
6. Finally, indicate any other medications you are currently taking and sign the form with the date.

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