Walgreens Specialty Pharmacy > Authorize a caregiver

Print

Thank you for choosing Walgreens Specialty Pharmacy to provide you with personalized care to help you meet your treatment goals.

The form below allows you to authorize your caregiver or another individual designated by you to discuss your medications and health condition with our Customer Care Center staff.

The purpose of this form is to let Walgreens and the specialty pharmacy staff know your decision and to protect your privacy and health information.

After you have fully completed the form and signed it, please mail it to the Walgreens Privacy Office address as indicated on the form or fax it to 847-236-0862.

We respect your privacy as well as your wishes, so we encourage you to complete the form and return it to us as soon as possible. If you have any questions about the form or need to reach us, please call 888-782-8443.