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Forms

We require certain forms to be filled out here at King Pharmacy. For ease of communicating this information, we have uploaded frequent ones onto our website for new patients and other circumstances. Once completed, just send it back by email to kingpharmacytopeka@gmail.com or bring it in when you pick up your script.

New Patient

Below are the forms for all of our new patients. Please fill out one, read two, sign three, and bring them back in to our business or email them back to kingpharmacytopeka@gmail.com.

1

Patient Information

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Notice of Privacy Practice (NOPP) Information Sheet

2

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Notice of Privacy Practice (NOPP) Signature Sheet

3

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Other Forms

Finding the Balance - Symptom List Tracker

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Flavor Chart

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