kidsMedPacks

Easily-identifiable pre-packaged medications
for your children when they are away from home

		Medication Request Form (To Be Completed by Parent) To view this form, you will need Acrobat Reader

		Letter to Physician

	Download and Print
	MEDICATION REQUEST FORM (To Be Completed by Parent)
	LETTER TO PHYSICIAN
	Obtain Original Prescriptions if Needed.

Attach completed Medication Request Form (To Be Completed by Parent), original prescriptions and a copy (front & back) of your insurance card.

Mail to kidsMEDPACKS by deadline date:

kidsMEDPACKS
PO Box 568
Scarsdale, NY 10583

*A $35 late fee will be added to your bill if any information is received after the deadline date.