How can we help you? Help Center

Welcome to the Life-Assist Help Center. Having trouble and need support? You are in the right place!


Downloadable Forms

For your convenience, you can download the forms below and submit them to us via Fax or Email
Fax: 800.290.9794 | Email: [email protected]

RX Auth Form Perscription Item Ordering
Authorization Form
Download
Credit Application Download Credit Application
Download
Data Request Form Download Data Request Form
Download
Stock Request Form Download Stock Request Form
Download
Order Form Download Order Form
Download
Product Incident Report Form Download Product Complaint Form
Download
Need Assistance? We're here to help.
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800.824.6016
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Sat-Sun: Closed
Fax
800.290.9794
Live Chat
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Sat-Sun: Closed
Email Us
Mailing Address
Life-Assist
11277 Sunrise Park Dr
Rancho Cordova, CA 95742