Optumrx new form 2026

1. Click ‘Get Form’ to open the optumrx new form in the editor.
2. Begin by filling out Section 1. Enter your Primary Member ID Number and, if applicable, your Secondary Member ID Number. Provide your first name, last name, middle initial, delivery address, city, state, ZIP code, phone number with area code, email address, date of birth (mm/dd/yyyy), and gender.
3. Indicate any medication allergies you have by checking the appropriate boxes. If you have health conditions such as arthritis or asthma, check those as well.
4. In the section for over-the-counter/herbal medications taken regularly, list any relevant medications. If you want to keep prescriptions on file for later shipment, note them here.
5. Section 2 is for your physician. Ensure they fill it out completely or attach their office prescription before faxing the completed form to 1-800-491-7997.

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