Available below are blank forms to print or download for any new medications. Please have the prescriber sign and fax them to 1-317-536-3100, and we will take care of the rest.
New Patient Rx form
For maintenance therapy, Pharmaneek Pharmacy will fax a preprinted medication request in advance to avoid a routine prescription from not being filled on time.
Pharmaneek Pharmacy's prior authorization program
If you and your staff are interested in our prior authorization program that reduces the amount of time spent by medical staff completing forms and calls made to insurance companies, please call us at 317-293-1700.
If you would like to refer a patient to Pharmaneek Pharmacy, please fill out and fax the
Patient Referral Form to us or
click here for online submission. We will take care of the rest.
