Completed forms and original prescriptions can be mailed to:

Eagle Pharmacy
P.O. Box 90937
Lakeland, FL 33804

or emailed to:

or faxed to: (877) 283-9171

Request to Appoint a Personal Representative

Authorization for Eagle Pharmacy to provide access to Patients Protected Health Information (PHI) to another individual.

Prescription History Request

This form should be used by the patient or his/her Personal Representative to request printouts of the patient's prescription history.