Please completely fill out the credit card authorization form and mail, fax, or drop off at either pharmacy location. Payment is for co-pays, co-insurance, non-covered services, and deductables that are due at the time of dispensing medications.
A Contraceptive Self-Screening Questionnaire collects information about a person's medical history, lifestyle, and preferences to help determine the most suitable contraceptive methods for them. This information helps healthcare professionals assess the individual's eligibility and make informed recommendations for safe and effective contraceptive options.
Use this form to transfer your current prescription medications to one of the Ho-Chunk Nation's Pharmacies.