Welcome

Become a Priority Health Pharmacy patient.

A short, simple form is all it takes to get started.

Once you submit, our patient care team will reach out to verify your information and walk you through next steps.

HIPAA-safe submission notice: This web form is not a HIPAA-secure channel. Please do not include protected health information (PHI) — diagnoses, prescription numbers, dates of birth, member IDs, or clinical details. For prescription requests, call 845-789-5648 or fax 845-789-4104. By submitting, you acknowledge that any information you choose to include is provided voluntarily and may not be transmitted using HIPAA encryption.

How we use & retain your information: Priority Health Pharmacy collects your name, email, phone, and brief message solely to respond to your request and coordinate pharmacy services. We do not sell, rent, or share your information for marketing. Inquiry records are retained for up to 30 days after the request is resolved, then deleted — except where a service relationship, claim, or applicable law (HIPAA, state pharmacy regulations) requires longer retention. Each submission receives a verified confirmation ID and a server-side audit entry (without PHI) for accountability. You may request deletion at any time by emailing info@priority-rx.com. Learn more in our Privacy Policy and HIPAA Notice.

First name *

Last name *

Email *

Phone *

Year of birth (e.g. 1980)

ZIP code

Prescriber name

How can we help?

I confirm I am 18 years or older, or I am an authorized representative (parent, legal guardian, or caregiver) submitting this request on behalf of a patient.I acknowledge this web form is not a HIPAA-secure channel for protected health information, and I consent to be contacted by Priority Health Pharmacy by phone, email, or postal mail regarding my request. I understand my submission will be retained for up to 30 days after resolution and that I can request deletion at any time. I have read and agree to the Privacy Policy, HIPAA Notice, and Terms.(Optional) I consent to receive conversational and informational SMS messages from Priority Health Pharmacy at the mobile number provided. Consent is not a condition of purchase or service. Reply STOP to opt out; reply HELP for support. Message & data rates may apply; messaging frequency may vary. See our Privacy Policy and SMS Terms.

On submit, you'll receive a confirmation ID and our server records a non-PHI audit entry (timestamp, hashed contact, consent flags).