Transfer RX

To transfer your prescription to us, please carefully follow the instructions and fill out the form below.

Patient Details

First Name *

Last Name *

Date of Birth *

Phone Number *

Address*

City *

State*

Zip/Postal Code *

Pharmacy Name*

Pharmacy Phone *

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

Rx1 Med Name

Rx1 Number

Rx2 Med Name

Rx2 Number

Rx3 Med Name

Rx3 Number

Rx4 Med Name

Rx4 Number

Rx5 Med Name

Rx5 Number

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Dependable Drugstore in Lincoln, CA

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