Prescription Transfers (From Other Pharmacies)

DISCLAIMER: By law, NARCOTIC AND RESTRICTED MEDICATIONS CANNOT BE TRANSFERRED, BENZODIAZPINES (ex: diazepam, lorazepam, clonazepam, etc.) CAN ONLY BE TRANSFERRED ONCE. Pharmacies are not connected. We use this information to call other pharmacies to obtain the transfer. Thank you for your understanding.

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Name *

Email Address *

Date Of Birth

Phone

Tel Number Of Pharmacy To Transfer From

Type Prescription Numbers Or Names Of Medications You Would Like Transferred

Please Indicate Prescriptions You Would Like Filled Now, And Which Ones To Hold For Later:

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