Pharmacy transfer request form 2025

1. Click ‘Get Form’ to open the pharmacy transfer request form in the editor.
2. In Section 1, enter the Pharmacy Information. Fill in the Pharmacy Name, Telephone Number (including area code), Street Address, and City/Province.
3. Proceed to Section 2 for Patient Information. Provide your Last Name, First Name, Street Address, and City/Province.
4. In Section 3, input Prescription Information. List the prescription numbers and medication names for each prescription you wish to transfer. You can add up to ten prescriptions.
5. Once all sections are completed, review your entries for accuracy before submitting the form.
6. Submit the completed form via mail, fax, or email as indicated at the bottom of the document.

Start using our platform today to easily complete your pharmacy transfer request form for free!