AvMed makes it easy to manage your account by providing forms and other tools for making requests. Simply print and fill out one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
Individuals and Families
- Appointment of Representative
- Designated Record Set (DRS) Request
- Member Disclosure Form
- Medical Direct Member Reimbursement Form
- Medication Exception Request Form
- Pharmacy Reimbursement Form - AvMed pharmacy reimbursements are processed by CVS Caremark.
- Optum Mental Health Direct Reimbursement Form
- Rx - Mail Order Form
- Rx - Mail Order Form - Spanish