Enrollment Forms

To initiate an enrollment for your patient, simply download the appropriate form, complete and FAX it to City Drugs at (212)-988-4501. Our dedicated team will contact you when we receive the enrollment and communicate with you throughout the process. If you have any questions, please contact us at (855) 988-4500.

Click the appropriate link below to initiate enrollment now.

• Rheumatology Enrollment Form
• Hepatitis C Enrollment Form
• HIV/Hepatitis B & C Enrollment Form
• Oncology Enrollment Form
• Crohn’s Disease Enrollment Form
• Dermatology Enrollment Form
• Gastroenterology Enrollment Form
• Trelstar Enrollment Form
• Urology Enrollment Form
• Neurology Enrollment Form