IMPORTANT NOTICE:

This form has 2 Sections

Section 1 - Doctor Update
Section 2 - Medication Update

You MUST hit "SUBMIT" button after each section to transmit information.



SECTION 1:
doctor
pharmacy
hospital
update form





Please complete for accurate plan matching assistance.

If you do not have a preferred pharmacy/hospital or a primary care doctor, please type "none" in the field and you will be able to select one from the plan your plans network of providers.

If you DO NOT have any specialist, please leave those fields blank.

All fields with a * are required to submit this form.







































Please ensure you have completed ALL areas with a * before hitting submit.


A member of our team will reach out to you to verify your information.

Thank you for choosing The Trademark Group.
















submit >

SECTION 2:
medication form





Please complete for accurate plan matching assistance. If you don't take any medications, please type "NONE" in the first field.

PLEASE FOLLOW THIS EXAMPLE WHEN ENTERING YOUR MEDICATION

EXAMPLE: Amlodipine, 5mg, 1 per day





















































Please ensure you have listed all of your medication before hitting the submit button below. A member of our team will reach out to you to verify your information. Thank you for choosing The Trademark Group.














submit >

THE TRADEMARK GROUP





912-231-7818


SALES@TRADEMARKSERVICESGROUP.COM



7370 HODGSON MEMORIAL DR SUITE F3, SAVANNAH, GA 31406


912-231-7818

THE TRADEMARK GROUP INC