By Completing this form you are opting to receive your prescriptions through Liberty’s mail order pharmacy, McNeill’s Pharmacy.

Thank you for choosing McNeill's Pharmacy to care for you. We look forward to having you as part of our McNeill's Pharmacy family. Please feel free to reach out to our pharmacy staff with any questions or concerns you may have. We are always here to assist you!

Please complete and fax the front and back of this form to McNeill’s Pharmacy so we can process, fill, package and provide you with your medications. This information will be utilized to create your patient profile. This information is confidential and will be kept on file at McNeill's Pharmacy for pharmacy personnel only.

• Phone: 910-642-3065
• Toll Free: 866-908-3009
• Fax: 910-642-3765
• Email: McNeillsRetailPharmacy@liberty-healthcare.com