NeedyMeds Order Form
Use this order form to request a free information packet (brochure, drug discount card, information handout) from NeedyMeds. After completing contact information below, continue with order to next page to place your information request. If you want to request information for PAPTracker software, Patient Advocate Newsletter, Patient Assistance Program Update Service (PAPUS) or partnership information, do so before continuing to next page.
If this is your first order, fill out the form below. If you have previously submitted an order, search for your information.
If this is your first order, fill out the form below. If you have previously submitted an order, search for your information.
Search for your Drugs
