New Patient Form


    1. I understand that the pharmacist on duty in his/ her professional opinion may deny delivery of my medication and instead require me to pick them up in person.
    2. I understand that I am responsible for costs of my prescription and payment due upon delivery unless otherwise stated by pharmacist in charge. I also acknowledge that the delivery driver maybe able to make limited change, cannot accept credit card payments , but may accept personal checks.
    3. I understand that if I amnot present upon delivery of my medications, the driver will wait no longer than Five (5) minutes before leaving, at which point a delivery maybe reattempted after speaking to a pharmacy staff member to confirm time and any special instructions.
    4. I understand that if I am unable to personally take my delivery, I will inform the pharmacy of whom may accept it on my behalf, as well as any other special instructions that will ensure a safe delivery.
    5. I understand that my medications may not be returned to the pharmacy unless a prescription was filled incorrectly in accordance with New Jersey State Law.
    6. I understand that deliveries are not guaranteed. If there are any issues with delivery, I will be notified by the pharmacy as soon as possible. New prescriptions will require me to contact the pharmacy in order to arrange pick up and delivery.
    7. I understand that by signing below I give consent to Optimal Pharmacy inc, my signature authorization for deliveries in the year 2020.
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