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NewEra Pharmacy

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Patient Forms

Contact Us

Patients:

  1. Print the appropriate form for your clinician and have them fax or call in the order to NewEra.
  2. Call NewEra Pharmacy after filling out New Patient Registration Form below to verify all payment and billing information.
  3. You can elect to pick up your medication or have it shipped to you.
Online New Patient Registration Form

Clinicians:

  1. Download the appropriate patient forms below and fill them out.
  2. Fax the forms to 503.222.4868.

Downloadable Forms

Universal Claim Form
Specialty Pharmaceutical Ordering Forms

FERTILITY

General Fertility Form

HORMONE REPLACEMENT THERAPY

Compounding Form

COMPOUNDED MEDICATIONS

Other Compounding Form

PAIN MANAGEMENT

Pain Management Form

New Patient Registration Form

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New Era Pharmacy

Contact Us

  • 1286 SE Holgate Blvd. Suite C2
  • Portland, OR. 97202
  • 503.222.4822 or 877.252.9393
  • 503.222.4868
  • [email protected]

Hours

  • Monday-Friday 9am-5pm PST
  • Saturday 9am-1pm PST
  • Closed on Sunday

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PCAB Accredited
ACHC Accredited

© 2021 · NewEra Pharmacy