Enrollment Forms

Quickly download the forms you need, then choose from three simple options for sending us a specialty prescription:

  • eScribe to Giant Eagle Specialty Pharmacy or to one of our retail pharmacies
  • Fax an enrollment form to 1-877-645-4142

Please allow for a 24-48 hour turn around time for all prescriptions.

Enrollment forms must be completed and faxed by prescribing practitioners only.