Skip to main content Skip to footer
American Family Children's Hospital
SHARE TEXT
 

Authorization to Mail or Deliver Controlled Substance Prescriptions

UW Health Pharmacy Services is asking its patients to verify the addresses to which we can deliver prescriptions. Please complete the form below, making sure to enter all authorized shipping addresses to which we can deliver prescriptions.

 

If you have any questions while completing this form, please contact UW Health Pharmacy Services at (608) 890-9306.

 

 

Authorized Shipping Addresses

 

Please enter the addresses you authorize for prescription deliveries. You can enter up to three authorized addresses.

 

Please include the city, state and ZIP Code with your address.

 

 

 

 

 

By selecting the check box below, I authorize UW Health Pharmacy Services to deliver or mail Schedule II and III controlled substances to me at the address provided above. I understand that if my preferred delivery address changes, a new form will have to be submitted to UW Health Pharmacy Services to receive prescriptions at that location.