Forms & Documents
See below for links to our online forms and important downloadable documents. When completing one of our online forms, we recommend using a device with a touchscreen so that you can use your finger to sign (but a laptop or desktop computer works, too).
Having trouble accessing or need a hard copy of one of our online forms? Send us a message here.
A quick how-to for our online forms
All of our online forms are hosted through Jotform, a HIPAA-compliant form software. To complete one our Jotforms, start by clicking on the appropriate link below and then fill out the form’s fields by typing, clicking, etc. Please read question carefully and be sure to input correct information (e.g., we often have patients accidentally submit their date of birth, set the expiration date as the current date, or use a nickname instead of their legal name); forms that are submitted with incorrect information will need to be resubmitted. Questions with a red asterisk (*) are required in order to submit a form. Please also note that forms can only be submitted by the patient or a legal guardian/Power of Attorney (e.g., your spouse can’t submit a form on your behalf just because you gave them permission to).
Most of our forms will serve as a legally binding document that requires an electronic signature before submitting, which can be done either by signing with your finger (on a device with a touchscreen) or holding down the left click button on your mouse and dragging your cursor across the signature field (on a device without a touchscreen). If you have difficulty signing electronically, let us know and we can send you a hardcopy version of the form you’re attempting to complete instead.
Frequently needed forms
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Intake form for new patients that haven’t filled a prescription or received a vaccine at St. Paul Corner Drug. After completing this form, please give us a call so that we can further assist you.
Click here to access the online version of this form.
To view our New Patient Packet, which details important information about our processes and policies for new patients, click here or scroll lower down this page.
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Request form that can be completed by the Patient or a Patient Representative allowing St. Paul Corner Drug to be able to share private health information with individuals others than the Patient. This is commonly referred to as an "ROI" or "PHI" form.
Click here to access the online version of this form.
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Authorization form for patients who are a part of our Cost Plus self-pay program.
Click here to access the online version of this form.
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A fillable PDF consent form for all of the vaccines we provide. For more information about our vaccination services, visit our Vaccination page.
Click here to access this form.
To complete it, start by downloading the form to your device (DO NOT open in Google Docs, this alters the document’s formatting). Once downloaded, open the file and enter your information in the fillable fields as directed. After completing all fields, save it as a new document on your device. You can either print it and bring it with you to your appointment or email it to us at pharmacy@stpaulcornerdrug.com.
Our policies
New patients
Patient authorization
& request forms
Vaccination
(Vacunacíon)
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Describes our privacy practices and the rights you, the individual, have as they relate to the privacy of your protected health information (PHI) per the Health Information Portability and Accountability Act (HIPAA) of 1996. All new patients are required to acknowledge receipt of this policy upon pickup of your first prescription or vaccination.
Click here to access a PDF of this policy.
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Describes our standard procedure regarding transgender, transitioning, and gender non-conforming patients whose legal name and/or sex do not accurately reflect their gender identity. Click here to visit our webpage about this policy.
Click here to access a PDF version of this policy.
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Intake form for new patients that haven’t filled a prescription or received a vaccine at St. Paul Corner Drug. After completing this form, please give us a call so that we can further assist you.
Click here to access the online version of this form.
To view our New Patient Packet, which details important information about our processes and policies for new patients, click here or scroll lower down this page.
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Document detailing important information about our processes and policies for new patients. This is REQUIRED reading for all new patients to ensure that we can provide you the safest, smoothest service and care.
Click here to access a PDF version of this packet.
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A fillable PDF flowchart you can use to keep track of your daily medication regimen.
Click here to access this form.
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Request form that can be completed by the Patient or a Patient Representative allowing St. Paul Corner Drug to be able to share private health information with individuals others than the Patient. This is commonly referred to as an "ROI" or "PHI" form.
Click here to access the online version of this form.
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Authorization form for patients who are a part of our Cost Plus self-pay program.
Click here to access the online version of this form.
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Request form that can be completed by the Patient or a Patient Representative to receive a copy of the Patient’s medical expenses via mail or email (commonly used for filing taxes).
Click here to access the online version of this form.
note: For pick up in person or curbside at the pharmacy, please make your request at the time of pickup rather than completing this form.
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Form to request that we transfer a prescription to us from another pharmacy. Note that this is NOT the correct form for new patients, who should complete our New Patient Intake Form and provide any transfer requests there.
Click here to access the online version of this form.
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Request form that can be completed by the Patient or a Patient Representative to receive a copy of the Patient’s medical record.
Click here to access the online version of this form.
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A fillable PDF consent form for all of the vaccines we provide. For more information about our vaccination services, visit our Vaccination page.
Click here to access this form.
To complete it, start by downloading the form to your device (DO NOT open in Google Docs, this alters the document’s formatting). Once downloaded, open the file and enter your information in the fillable fields as directed. After completing all fields, save it as a new document on your device. You can either print it and bring it with you to your appointment or email it to us at pharmacy@stpaulcornerdrug.com.
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Formulario de consentimiento en formato PDF para completar para todas las vacunas que ofrecemos. Para obtener más información sobre nuestros servicios de vacunación, visite nuestra página de Vacunación.
Haga clic aquí para acceder a este formulario.
Para completarlo, comience por descargar el formulario en su dispositivo (NO lo abra en Google Docs, ya que esto altera el formato del documento). Una vez descargado, abra el archivo e ingrese su información en los campos que se pueden completar según las instrucciones. Después de completar todos los campos, guárdelo como un documento nuevo en su dispositivo. Puede imprimirlo y llevarlo a su cita o enviárnoslo por correo electrónico a pharmacy@stpaulcornerdrug.com.
