b'Patient Concern and Complaint FormBecause were working 2gether to meet your therapy goal, the pharmacy is committed to improving your journey whenever BIOPLUS SPECIALTY PHARMACY PATIENT GUIDEBOOKpossible. We value our relationship with youour patientand strive to provide you with products and support services to your complete satisfaction.If you are not happy with the care you get from us, we want to know about it. If you have any concerns or problems with your medications, services, etc., please call the number on your prescription label. Were here to help you every step of the way.If you wish to file a complaint or concern in writing, please fill out the form fields below marked with a * symbol. When you complete this form, please return it to the pharmacy by mail. You will receive a verbal and/or written response from our pharmacy within five (5) business days of receipt. . You may also call our toll-free number on your prescription label 24 x 7 x 365, we can assist you at any time.*Patient Name:_________________________________________________ *Date:________________________________________________________________________________________*Patient Address: ________________________________________________________________________________*Patient Telephone Number: _______________________________________________________________________*Description of Complaint: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________*Patient Signature: ________________________________________________________________________________Rev. 1/202432 The BioPlus Family of Pharmacies'