Switch Pharmacies

Transfer Your Prescriptions

Tell us what you take and where you fill today - our team will coordinate the transfer with your current pharmacy. No paperwork on your end.

Transfer Request Form

All fields marked with * are required

Patient Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Current Pharmacy

Pharmacy Name *

Pharmacy Phone (if known)

Medication Name(s) *

Rx Number (if known)

Additional Notes

I confirm this transfer request is for myself or someone I am authorized to represent.