Transfer your prescription to our drugstore. Send us your details online using the form on this page:

Patient Details

Prescriptions to be transferred

If you would like to transfer all prescriptions, simply check the box below.
Transfer all my prescriptions

If you would like to selectively transfer your prescriptions, simply start typing to find your medication.

List specific prescriptions to be transferred

                             MEDICATION NAME                                                                                  PRESCRIPTION NUMBER FROM CURRENT PHARMACY
Rx1 Med Name Rx 1 #
Rx2 Med Name Rx 2 #
Rx3 Med Name Rx 3 #
Rx4 Med Name Rx 4 #
Rx5 Med Name Rx 5 #