New Patient Intake Form

As your starting point for good health, one of our goals here at Springfield Pharmacy™ is to help streamline New Patient Enrollment for caregivers, getting patients the medication(s) they need as quickly as possible. That's why we offer a quick, simple way to submit your New Patient Intake Form here, online. Simply select Get Started, fill out the form and submit.  It's that easy.


If you prefer to download the form and fax it to us, click here.

Portrait of a young friendly female nurse or a doctor.