Wake Forest Baptist Health Prescription Mail Service: New Patient Enrollment Form

Receive up to a 90-day supply of eligible maintenance medications delivered to your home at no additional charge!  Prescription mail services are open to current employees and dependants of Wake Forest Baptist Health with active MedCost insurance. 

Mailing restrictions apply to states outside of North Carolina.

Please note: You will need to complete an enrollment form for each family member. 

Optional Shipping Information If Different From Above
Contact Information
Patient Information
Medication Information

Please provide the requested information below for any medications you would like to receive via mail. Medications listed will, by default, be filled and delivered via mail to the shipping address specified above. Refills will not be initiated until requested by the patient.