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Fill out, sign and send any form in a few minutes. Each one reaches our pharmacy team as a secure PDF, and we reply within one business day.

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Patients & families

New patient registration
Refill a prescription
Transfer prescriptions to Solace
New prescription — contact my doctor
Schedule a free delivery
Medication sync & bubble pack sign-up
Vaccine appointment & screening
Caregiver & family authorization

Facilities & long-term care

Facility partnership application
New resident admission
Facility refill & reorder
Medication change or discontinue notice
On-site vaccine clinic request

Prescribers

Prescriber request

General

Send us a message

Prefer to call?(209) 635-5260

New patient registration

Become a Solace Care patient. We set up your profile, contact your doctors and check your insurance.

Patient

Patient name *

Date of birth *

Phone *

Gender

Home address *

City *

ZIP code *

Preferred language

Best way to reach you

Phone call Text message Email

Health information

Allergies *

Medical conditions

Current medications

Primary doctor

Doctor's phone

Insurance

Do you have prescription insurance? *

Yes No, I'll pay cash

Insurance plan

Member ID

Group number

Rx BIN

Rx PCN

Cardholder name

Services

Pickup or delivery *

Free local delivery Pick up at the pharmacy

Delivery address *

I'm interested in

Transferring my prescriptions Medication sync (one pickup a month) Bubble packs Refill reminders Vaccines Medication review with a pharmacist

Consent

I confirm this information is correct. I authorize Solace Care Pharmacy to contact my doctors and other pharmacies about my prescriptions and to bill my insurance. *

Signed by (print name) *

Relationship to patient

Signature *

Sign with your finger or mouse

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Refill a prescription

Send your Rx numbers or medication names. We'll have them ready or deliver them free.

Patient name *

Date of birth *

Phone *

Rx numbers

Needed by

Medications to refill *

Pickup or delivery *

Free local delivery Pick up at the pharmacy

Delivery address *

Notes for the pharmacist

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Transfer prescriptions to Solace

Switching is easy. Tell us where your prescriptions are now and we do the rest.

Patient name *

Date of birth *

Phone *

Current pharmacy

Pharmacy name *

Pharmacy phone

Pharmacy city

What should we transfer? *

All my prescriptions Only the ones I list below

Medications *

Packaging

Put my medications in bubble packs Sync my refills to one day each month

Pickup or delivery *

Free local delivery Pick up at the pharmacy

Delivery address *

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

New prescription — contact my doctor

Need a new prescription or a refill authorization? We'll contact your doctor for you.

Patient name *

Date of birth *

Phone *

Doctor's name *

Doctor's office phone *

Clinic or practice

Request *

New prescription Refill authorization (no refills left) Change in medication or dose

Medication(s) *

Doctors can also e-prescribe directly to Solace Care Pharmacy in Atwater. We cannot fill a prescription from a photo.

Pickup or delivery *

Free local delivery Pick up at the pharmacy

Delivery address *

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Schedule a free delivery

Free local delivery of prescriptions to your home or office.

Patient name *

Phone *

Delivery address *

City *

Preferred day *

Time window

Medications for delivery *

Gate code or delivery notes

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Medication sync & bubble pack sign-up

All your monthly medications ready on one day, sorted by day and time if you like.

Patient name *

Date of birth *

Phone *

Caregiver name

Caregiver phone

Services *

Sync all my refills to one date Weekly bubble packs Monthly bubble packs Delivery with each cycle

Preferred sync week

Medication list *

I agree to have my medications synchronized and packaged by Solace Care Pharmacy. I'll call if my doctor changes a medication. *

Signed by (print name) *

Relationship to patient

Signature *

Sign with your finger or mouse

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Caregiver & family authorization

Let a family member or caregiver pick up prescriptions or discuss your medications.

Patient name *

Date of birth *

Phone *

Authorized person

Authorized person's name *

Relationship *

Their phone *

They may *

Pick up my prescriptions Discuss my medications with the pharmacist Receive refill reminders Pay for my prescriptions

This authorization ends onLeave blank to keep it until you cancel it in writing

I authorize Solace Care Pharmacy to share my prescription information with the person named above for the purposes I checked. I can cancel this at any time in writing. *

Signed by (print name) *

Relationship to patient

Signature *

Sign with your finger or mouse

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Facility partnership application

RCFEs, SNFs, group homes and hospice: tell us about your facility and we'll set up a visit.

Facility

Facility name *

License type *

License number

Address *

City *

Licensed beds

Current residents

Current pharmacy

MAR system

Preferences

Packaging

Multi-dose bubble packs Unit-dose bubble packs Vials Not sure yet

Fill cycle

Weekly Every 14 days Monthly (28 or 30 days)

Services you need

Printed MARs LIC 622 medication records eMAR integration Medication carts & supplies Staff medication training Pharmacist medication reviews On-site vaccine clinics Same-day emergency delivery

Contact

Contact name *

Title

Phone *

Email *

Best time to visit

Notes

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

New resident admission

Start medications for a new resident. We'll verify orders with the prescriber and deliver.

Facility

Facility name *

Staff name *

Staff phone *

Staff email

Resident

Resident name *

Date of birth *

Room or bed

Admission date *

Allergies *

Diagnoses

Primary physician *

Physician phone *

Medicare Part D plan

Medi-Cal or other insurance

Member ID

Medications

Current orders *

Medications needed today? *

Yes — first doses today No — next scheduled delivery

Packaging start date

I confirm I'm authorized by the facility to send this admission and that the information matches the resident's current orders. *

Signed by (print name) *

Staff signature *

Sign with your finger or mouse

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Facility refill & reorder

Reorder for several residents at once. Add a row for each medication.

Facility name *

Staff name *

Phone *

Delivery *

Next scheduled delivery Today — urgent

Needed by

Medications

Notes

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Medication change or discontinue notice

Tell us about new orders, dose changes, holds or discontinued medications.

Facility name *

Staff name *

Phone *

Resident name *

Date of birth *

Change *

New order Dose or direction change Hold Discontinue

Medication *

Details *

Prescriber *

Order date *

Effective date

Packaging

Re-pack the current cycle Apply at the next cycle

Signed by (print name) *

Staff signature *

Sign with your finger or mouse

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

On-site vaccine clinic request

We bring vaccines to your residents and staff.

Facility name *

Address *

Contact name *

Phone *

Email *

Residents to vaccinate

Staff to vaccinate

Vaccines *

Flu COVID-19 Shingles (Shingrix) Pneumonia (pneumococcal) RSV Tdap / tetanus Hepatitis A

Preferred dates *

Notes

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Prescriber request

Questions, prior authorizations and facility orders. Prescribers can also e-prescribe to us.

Prescriber name *

Practice *

NPI

Phone *

Fax

Email *

Request type *

Patient name

Patient date of birth

Details *

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.

Send us a message

General questions. We reply within one business day.

Name *

Phone *

Topic

Message *

Leave this empty

Sent securely to our pharmacy team as a PDF. Fields marked * are required.