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I need a
prescription refill
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prescription refill
details
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Next Refill Date
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I need a
prescription refill
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I need a
prescription refill
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and
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I have a
medical need
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specify using the "Other" section below.
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I have a
medical need
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Answer
a Few Questions:
When did this start?
1
2
3
Hours
Days
Weeks
Months
Years
Severity
Mild
Medium
Severe
What Caused This?
I Don't know
Nothing
Have you had this problem before?
Yes
No
What makes this feel better?
Nothing
Rest
Other
What makes this feel worse?
Nothing
Other
Anything else you’d like us to know?
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I have a
medical need
Please confirm information provided you and schedule a call
Selected Symptoms
When did this start?
Severity
What Caused This?
Have you had this problem before?
What makes this feel better?
What makes this feel worse?
Anything else you’d like us to know?
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I have a
medical need
Request Received!
Expect a callback on
from
(623) 334-4000.
Thank you! Your request has been received.
We'll get back to you right away... Shouldn't be more than 30 minutes.
Thank you! Your request has been received.
We'll get back to you between
and
on
.
I need
something else
What can we
Help
you with?
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I need
something else
Request Received!
Expect a callback on
from
(623) 334-4000.
Thank you! Your request has been received.
We'll get back to you right away... Shouldn't be more than 30 minutes.
Thank you! Your request has been received.
We'll get back to you between
and
on
.
Send me
my ID card
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+1
Do you have a medical need?
Yes
No
Do you have a prescription need?
Yes
No
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Send me
my ID card
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We'll text you the membership card on
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I don't understand
my benefits
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Best number to call?
+1
Do you have a medical need?
Yes
No
Do you have a prescription need?
Yes
No
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I don't understand
my benefits
Request Received!
Expect a callback on
from
(623) 334-4000.
Thank you! Your request has been received.
We'll get back to you right away... Shouldn't be more than 30 minutes.
Thank you! Your request has been received.
We'll get back to you between
and
on
.