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Optum Specialty Phone: 877-445-6874 | Optum Specialty Fax: 877-342-4596 . Specialty Pharmacy Enrollment Form . This form is not a valid prescription in Arizona . Please detach before submitting to a pharmacy – tear here . PATIENT INFORMATION PRESCRIBER INFORMATION . Please complete the following or send patient demographic sheet . Prescriber ...

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Pay your bill by phone. Learn how to pay your bill by calling 1-877-445-8761. Getting Ready for your First Appointment New Patient Paperwork For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment.Pay your bill by phone. Learn how to pay your bill by calling 1-877-445-8761. Getting Ready for your First Appointment New Patient Paperwork For your convenience, you may complete new patient forms in advance. Please select and print from the options below, fill them out completely and bring them with you to your appointment.

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1-877-342-4596 Call 1-877-445-6874 Ready to prescribe? Just e-prescribe, fax or call in your patient’s prescription to Optum® Specialty Pharmacy. We’ll handle the rest. Once we receive the prescription, we will: • Complete a benefits investigation and prior authorization • Aid patients in obtaining financial assistance programs

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