Online Patient Assessments
Pharmacists can complete an online Patient Assessment Form to request a patient consultation by clicking the E-referral Intake Form link below.
- Affiliated pharmacists will have information already entered in our system. The pharmacist professional license number will be required in the Billing Number field to pull up your information.
- You will then be taken to a page to enter the patient demographics, attach any patient documentation/consent forms and complete a health history form. Attaching the patient’s prescription history will save time from manually entering the data later in the online form.
- Consent forms and prescription history may also be faxed to 1-866-MCMS-FAX (626-7329).
If the patient prefers, pharmacists can have the patient use our online self assessment form to complete an intake from home.