Accept Your Notice of Privacy Practices

Under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), Walgreens is required to provide you with a Notice of Privacy Practices that describes how we may use your information for treatment, payment and other purposes and that details your rights regarding the privacy of your health and medical information. We are also required to request that you acknowledge our delivery of this notice to you.

  • Submit the prescription name, dosage, and your pharmacy details. 
  • We'll route for approval and let you know when your prescription request is ready.
  • Sign up for text or email alerts & we'll let you know when your request has been submitted to your pharmacy.

Please do not use this form for Schedule II Controlled Substances1 - Cannot be requested online due to federal regulations.

Name *
Name
Name, Location, Phone Number
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