Prescription Pickup Authorization Form - Hotel Pharmacy 2026

1. Click ‘Get Form’ to open the Prescription Pickup Authorization Form in the editor.
2. Begin by filling in your name in the designated space at the top of the form. This identifies you as the patient authorizing someone else to pick up your medications.
3. Next, provide the name of the individual you are authorizing to pick up your prescriptions. Ensure this person is aware and can present valid identification.
4. Fill in the address of The Hotel Pharmacy, which is pre-filled for your convenience, ensuring accuracy.
5. List any specific medications you are authorizing for pickup. If you wish to authorize all medications, simply write 'ALL' in the provided space.
6. Check the HIPAA release box to allow The Hotel Pharmacy to share necessary medical information with your authorized individual. Remember, this form is invalid without this check.
7. Finally, sign and date the form at the bottom. If applicable, have a legal guardian sign as well.

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