Medication Therapy Management (MTM)

Please Complete Your Intake Form

To help our pharmacist prepare for your consultation, please complete the intake form using the link provided. We ask that you provide complete and accurate information regarding your current medications, supplements, health history, and any questions or concerns you would like to discuss during your appointment.

Your completed intake form must be received at least two (2) business days before your scheduled appointment. This allows our pharmacist adequate time to review your information and prepare for a personalized and productive consultation.

If we do not receive your completed intake form by the deadline, your appointment will need to be rescheduled to allow sufficient time for pharmacist review.

Thank you for helping us prepare for your visit. We look forward to working with you!

Uptown Chemist Team
Personalized care. Your hometown pharmacy.