Rx Drug Lookup - Apex Retirement Solutions

Complete the below form and someone from our office will contact you as soon as possible.

Rx Drug Lookup Form

Name

First

Last

Phone

ZIP Code

What is your preferred pharmacy?

Are you open to having your prescriptions mailed to you, if it saves you additional money?

Yes

Medications

List your medications below. Click Add button to add more.

Drug Name

Dosage

MG amount

Times Per Day

Add Remove

Providers

Please list your providers below. Click Add to add additional providers.

First name

Last name

Specialty

City

ZIP Code

Add Remove

Questions or comments

By completing this form you agree that a licensed insurance agent may contact you by phone or email to answer any questions you have regarding Medicare plans. This is a solicitation for insurance.

If you are human, leave this field blank.