AllianceMeds Enrollment | Workers' Comp Pharmacy Delivery Service

Sign Up To Get Your Medications On Time Without Delay

AllianceMeds has a team of professionals who understand the workers’ compensation process and have been helping injured workers, like you, receive their medications for over 10 years. We understand the hassles injured workers face when they try to get their medications filled. Insurance Companies deny treatment, often in violation of the law, and then other pharmacies refuse to fill medications or require the injured worker to pay for medications out-of-pocket. AllianceMeds is different! We fill medications even when treatment is denied or the case is in litigation.

Enroll with AllianceMeds today to ensure that you receive uninterrupted medications. Our enrollment process is quick and easy. Simply fill out the form below and one of our representatives will contact you to complete the enrollment process and schedule delivery of your medications.

If you prefer to mail or fax your information instead, please download a copy of the enrollment form by clicking here.
Or you can enroll by phone when you call (866) 929-8500.

Full Name(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Phone Location

Injury/Insurance Carrier Information

Date of Injury

Attorney's Name

Employer's Name

Insurance Carrier's Name

Insurance Carrier's Phone

Claim Number

Adjustor's Name

Physician Information

Physician's Name

Physician's Phone

Physician's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Comments

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Enroll With AllianceMeds

Sign Up To Get Your Medications On Time Without Delay

Injury/Insurance Carrier Information

Physician Information