Enrollment Forms

Submit the form directly to First Choice staff

Submissions to our Specialty Pharmacy may be completed using your own forms or prescriptions, please free to use those and email (referrals@fcsprx.com) or fax (1-844-324-3244).

We offer our forms focused on the areas of Specialty Pharmacy in order to best assist in patient care options. If you have any questions or feedback on these forms, please contact us and we will be glad to help in any way we can.