1. Personal Information

Full Name *

Phone *

Email *

Address

Street Address *

City *

State *

Country

Postal code *

**Your information will remain confidential and used only for support purposes.

2. Current Benefits & Healthcare Coverage

3. Immediate Prescription Transfer & Free Monthly Delivery

If you checked 'Yes,' click here to complete the prescription transfer form now [Prescription - OHC Pharmacy].

New patients also receive 10% off any OTC products + uninsured patients get special low-cost pricing, including $5 generics.

4. Home & Healthcare Needs

Are you interested in free health screenings or wellness programs? (Select one) *

Yes

Do you or a family member need home-delivered meals? (Select one) *

Yes

6. Next Steps: Prescription Transfer & Assistance

Would you like us to check if you qualify for additional healthcare or community benefits? (Select one) *

Yes

If you checked 'Yes' for prescription delivery, we will contact you to assist with transferring your prescriptions. Would you like us to call you today? (Select one) *

Yes

If you haven't already, click here to complete your prescription transfer form now: Prescription - OHC Pharmacy

By providing your contact information, you consent to receive communications from Optimistic Healthcare Solutions via phone, text message, email, or other means, including automated systems or AI-generated voice or text messages. Message and data rates may apply. You may opt out at any time. For questions or to update your communication preferences, please call or text us at (346) 585-7703.