Mail Order Form
Mail Order Form
Description
Qty
Price
Total
Total:
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Item #
Ship To:____________________________________________________________________________________ Address:___________________________________________________________________________________ Apt./Room #:_______________________________________________________________________________ City:_______________________________________ State:________________________ Zip:______________ Phone: (_____ )______________________________________________________________________________ Alternate Contact:____________________________________________________________________________ Phone: (_____ )______________________________________________________________________________
Member Name:______________________________________________________________________________ Member ID:_________________________________________________________________________________ Date of Birth:_______________________________________________________________________________
Detach Here
Orders will be processed the month in which they are received.
Eon Health and Fieldtex Products are not responsible for lost or stolen packages. For delivery issues, please contact your local post office or Fieldtex Products, Inc. at 1-800-353-7763 (TTY Hearing Impaired: 711) Monday - Friday 8:00 am to 5:00 pm.
The OTC benefit allowance varies based on the plan in which you are enrolled. You can only purchase OTC Products up to your benefit allowance.
Your monthly allowance will not roll over to the next month if not used.
You cannot use future allowance amounts when placing your order.
Important Things to Remember
Ordering is Easy!
Important Things to Remember
•
POST STAMP HERE
1. By mail: Fill out the attached mail order form and drop it in the mail. Be sure to give it 7 days to reach us. The order will be processed in the month that it is received, and we will return a mail order form with your shipment.
Please allow 7 - 10 days for delivery of in-stock items. You will be notified if an item is out of stock and may take longer for delivery. If mailing your order, please allow 1 week for mail delivery to Fieldtex. Orders will be processed the month in which they are received. If you receive a damaged item, call Fieldtex Products immediately at 1-800-353-7763 (TTY Hearing Impaired: 711) Monday - Friday 8:00 am to 5:00 pm. The item will be exchanged for an identical item at no cost to you. Please note that only damaged products can be exchanged within 30 days of purchase, no other returns are allowed.
•
If you disenroll from the Eon Health, your Over-TheCounter (OTC) benefit witll automatically terminate.
•
Products in the catalog should only be ordered for the enrolled member.
•
Products may not be pruchased at a local retail pharmacy or through any other source other than Fieldtex Products, Inc. Over-The-Counter Benefit Catalog.
•
For any other questions, regarding your health plan, please contact member services at 1-888-906-3889 (TTY: 711). Our hours of operations are from October 1 – February 14, seven days a week, from 8:00am – 8:00pm and from February 15 – September 30, Monday through Friday, 8:00am – 8:00pm (you may leave a voicemail Saturday, Sunday and Federal Holidays).
FIELDTEX PRODUCTS INC EON HEALTH ORDER DEPT 3055 BRIGHTON-HENRIETTA TL RD ROCHESTER NY 14623-9938
•
The health information provided in this catalog is general in nature and is not medical advice or a substitute for professional health care. It is provided for your information and convenience only. Fieldtex Products does not guarantee the accuracy or completeness of this information, and does not recommend or endorse the products referenced in this catalog.
FROM ______________________ ____________________________ ____________________________
•
Simply choose one of the options below: Mail order form, call Toll Free, or go online.
2. By phone: Call us at 888-246-6001 (TTY 711) Monday – Friday from 8 am to 5 pm, and our friendly customer service representatives will take your order. Be sure to have your member ID and birthdate available to allow us to access your account.
2018 Personal Health Care Products at NO COST to you! SM
Eon Health OTC Benefit 2018 Order Form
3. Online: visit us at www.fieldtex-eonhealth.com and log in to place your order. Online you will be able to keep track of what you have ordered, check status of orders, and check benefit allowance. Shop in the privacy of your own home.
Call us toll-free at 1-888-246-6001 (TTY 711) Monday-Friday 8:00 am to 5:00 pm or visit us online at
www.Fieldtex-eonhealth.com
www.Fieldtex-eonhealth.com
Description
Qty
Price
Total
Total:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Item #
Ship To:____________________________________________________________________________________ Address:___________________________________________________________________________________ Apt./Room #:_______________________________________________________________________________ City:_______________________________________ State:________________________ Zip:______________ Phone: (_____ )______________________________________________________________________________ Alternate Contact:____________________________________________________________________________ Phone: (_____ )______________________________________________________________________________
Member Name:______________________________________________________________________________ Member ID:_________________________________________________________________________________ Date of Birth:_______________________________________________________________________________
Detach Here
Orders will be processed the month in which they are received.
Eon Health and Fieldtex Products are not responsible for lost or stolen packages. For delivery issues, please contact your local post office or Fieldtex Products, Inc. at 1-800-353-7763 (TTY Hearing Impaired: 711) Monday - Friday 8:00 am to 5:00 pm.
The OTC benefit allowance varies based on the plan in which you are enrolled. You can only purchase OTC Products up to your benefit allowance.
Your monthly allowance will not roll over to the next month if not used.
You cannot use future allowance amounts when placing your order.
Important Things to Remember
Ordering is Easy!
Important Things to Remember
•
POST STAMP HERE
1. By mail: Fill out the attached mail order form and drop it in the mail. Be sure to give it 7 days to reach us. The order will be processed in the month that it is received, and we will return a mail order form with your shipment.
Please allow 7 - 10 days for delivery of in-stock items. You will be notified if an item is out of stock and may take longer for delivery. If mailing your order, please allow 1 week for mail delivery to Fieldtex. Orders will be processed the month in which they are received. If you receive a damaged item, call Fieldtex Products immediately at 1-800-353-7763 (TTY Hearing Impaired: 711) Monday - Friday 8:00 am to 5:00 pm. The item will be exchanged for an identical item at no cost to you. Please note that only damaged products can be exchanged within 30 days of purchase, no other returns are allowed.
•
If you disenroll from the Eon Health, your Over-TheCounter (OTC) benefit witll automatically terminate.
•
Products in the catalog should only be ordered for the enrolled member.
•
Products may not be pruchased at a local retail pharmacy or through any other source other than Fieldtex Products, Inc. Over-The-Counter Benefit Catalog.
•
For any other questions, regarding your health plan, please contact member services at 1-888-906-3889 (TTY: 711). Our hours of operations are from October 1 – February 14, seven days a week, from 8:00am – 8:00pm and from February 15 – September 30, Monday through Friday, 8:00am – 8:00pm (you may leave a voicemail Saturday, Sunday and Federal Holidays).
FIELDTEX PRODUCTS INC EON HEALTH ORDER DEPT 3055 BRIGHTON-HENRIETTA TL RD ROCHESTER NY 14623-9938
•
The health information provided in this catalog is general in nature and is not medical advice or a substitute for professional health care. It is provided for your information and convenience only. Fieldtex Products does not guarantee the accuracy or completeness of this information, and does not recommend or endorse the products referenced in this catalog.
FROM ______________________ ____________________________ ____________________________
•
Simply choose one of the options below: Mail order form, call Toll Free, or go online.
2. By phone: Call us at 888-246-6001 (TTY 711) Monday – Friday from 8 am to 5 pm, and our friendly customer service representatives will take your order. Be sure to have your member ID and birthdate available to allow us to access your account.
2018 Personal Health Care Products at NO COST to you! SM
Eon Health OTC Benefit 2018 Order Form
3. Online: visit us at www.fieldtex-eonhealth.com and log in to place your order. Online you will be able to keep track of what you have ordered, check status of orders, and check benefit allowance. Shop in the privacy of your own home.
Call us toll-free at 1-888-246-6001 (TTY 711) Monday-Friday 8:00 am to 5:00 pm or visit us online at
www.Fieldtex-eonhealth.com
www.Fieldtex-eonhealth.com
