Questions? Call Toll-Free 800. 279. 5708


	HIPAA Form
	Customer Information Form


	Patient Info Request
	Practitioner Referral Request
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Billing

Billing representatives are available Monday through Friday 8:30 a.m. - 6:00 p.m. (CST)

Each prescription will be accompanied with an Invoice and a Prescription Information Sheet.

The Invoice is to verify the cost of each item ordered, the total items shipped, and the shipping charge.

The Prescription Information Sheet is included with each prescription and/or supplement to reflect the cost and may be used for insurance and/or income tax purposes and does not include the shipping charge.

For your convenience, Women's International Pharmacy can automatically bill your VISA, MasterCard, Discover or American Express each time an order is processed when ordered by you or your practitioner. To take advantage of this secured service, please contact the Billing Department at 1-800-279-5708, press option 4.

For billing questions, please contact us at (800) 279-5708 (option 4) or send us an email.

> Click on each form to view detailed explanations.

Women’s International Pharmacy, Inc.
Toll Free Phone: 800. 279. 5708 ~ Toll Free Fax: 800. 279. 8011 ~ Email: info@womensinternational.com