Express Scripts Health, Allergy & Medication Questionnaire (HMQ)
Do not send prescriptions, refill slips, or correspondence with this questionnaire.
Mailing instructions are provided on the back of this form. FOLD HERE.
Express Scripts Mail Order Allergy Questionnaire : Useful Links
Send your prescription( s), Mail-Order Form, Health, Allergy and Medication Questionnaire, and ...
militaryrx.express-scripts.com
Mail. Fill out the Home Delivery Order Form (PDF) and then mail the form and your 90-day prescription to the address listed on the form ...
Send your prescription(s) and a completed Express Scripts mail-order form to the ... also complete and send the health, allergy, and medication questionnaire.
Mailing instructions are provided on the back of this form. FO. LD. H. ER. E ... Complete the Health, Allergy & Medication Questionnaire. There may be a ...
While you are online, complete a Health, Allergy & Medication Questionnaire so we can help protect you against drug interactions or allergies. Or, if you're ...
The Health, Allergy & Medication. Questionnaire (HMQ) Form is part of the mail order form and should be returned when mailing in a prescription. This ...
Order prescription drugs through the mail from Express Scripts Home Delivery. Health, Allergy and Medication Questionnaire Complete this questionnaire for all ...
You can use Express Scripts® and Walgreens mail-order pharmacies. It takes