Rx101 Downloadable
Forms
We use a secure site for all online payments.
However, if you prefer to complete an application and fax or
mail it to us, you are welcome to do so. Follow these simple
instructions:
- You'll need Adobe Acrobat to open this file,
if you don't have it you'll need to download and install
Acrobat Reader free by clicking
here.
- Open file and print from within the Adobe
Acrobat toolbar.
Enrollment
Form (2 pages)
- Complete application and include payment
or payment information. Please remember, we do not send bills
and must have an automatic payment from either a checking,
savings or credit card. However, if you pay for the year,
we will send you a bill in the 11th month.
- Fax or mail your application to:
| Fax: |
216-472-8002 |
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| Mail To: |
Heritage Consulting Group
2301 Payne Avenue
Cleveland, OH 44114 |
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- Be sure to print our "Doctor's
Prescribing Guide" and take it to your next doctor's
appointment.
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