Patient Forms

New Patient

Patient Forms

Prescription and Refill Orders

 Your prescriber must send a valid prescription to our pharmacy via their preferred means. Please note, certain controlled substance medications cannot be faxed to the pharmacy by law and a paper copy of these prescriptions must be sent to the pharmacy.

Once a valid prescription is on file, you may call into our pharmacy at any time to place your order and setup a shipment.

At any time, you can call the pharmacy to speak with a staff member. Please have the following information available: medication name, your first and last name, address, date of birth, daytime phone number

Treatment Advocate will call before refill is due to schedule a delivery of your refill or you may call your Treatment Advocate directly.

Your prescription may be filled with a generic equivalent substitution based on state law, equivalency rating and in accordance with company policy. Please ask a pharmacist if you have any questions or concerns.

 Contact your Treatment Advocate directly or call the pharmacy at 800-540-4700 and we will transfer the prescription to the pharmacy of your choice.

We will let you know if we are unable to fulfill the medication prescribed and provide you with the information on where you can get your prescription filled.
We will transfer the prescription to the appropriate pharmacy.
After you have spoken to your Treatment Advocate to place your refill order, you may check your order status by signing up for our Text Message program by going to PPS TEXT MESSAGE PROGRAM or by calling or emailing your Treatment Advocate directly. Your prescription number can be found on one of your prescription bottles or packages or labels or on the statement of account invoice that was sent with your last order. 

Emergency Preparedness

Emergencies and disasters can occur anytime anywhere. Planning ahead and making provisions for you and your family’s needs can make a big difference in being able to cope with emergencies. In case of any emergency or disaster, we will attempt to prevent any disruption in your service. If you have any emergency and we are unable to get in touch with you we advise you to go to the nearest hospital. Here are some questions to ask yourself:
  1. Where can I find recommendations and information for preparing for an emergency?
  2. Where can I find a list of people, companies, and organizations that can assist me if there is an emergency?
  3. What kind of supplies or things should I have set aside?  
Below you will find the answers to these questions and more.
  • You should develop a realistic preparedness plan in advance of any emergency or disaster.  You should have at least a 72-hour emergency supply of food, water, medications and necessary medical supplies, a portable radio, flashlight and batteries. If you have pets you should have supplies for them.
  • Select a family member or friend who lives out of the immediate area to act as a contact person for you and your family. More often than not it is easier to make a call outside the area following a disaster. Make sure you give this person’s name and phone number to Polaris Pharmacy Services. We may need to call this person to try and locate you after the emergency so that the necessary services may be provided to you.
For additional information on how to prepare for an emergency, go to

Adverse Reactions and Concerns

If you suspect that you’re experiencing a severe or life-threatening adverse reaction, call 9-1-1 immediately.
For non-life threating reactions contact us at 800-540-4700 and speak with a Pharmacist.

Medication Recalls

Contact Us: 800-540-4700