Forms
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
Pharmacy Direct Member Reimbursement Form
Mental Health Direct Member Reimbursement Form
Rx - Mail Order Form
Rx - Mail Order Form - Spanish