PATIENT PRESCRIPTION TRANSFER REQUEST FORM

Please use the following form to request a prescription pharmacy transfer.

For any questions, please contact our front office using the chat bubble below.

 

The conditions to request a transfer of a prescription are as follows:

 

  • Each transfer request must be made using our online prescription transfer form (no texts, chats, emails or calls)
  • The online Prescription Transfer Form can be found here.
  • Each transfer request costs $28, to cover the Provider time required to process.
  • Each prescription requires a separate transfer form to be submitted.
  • If you have multiple months of the prescription outstanding ALL will be cancelled and transferred.
  • Your Default Pharmacy on record will not change unless you request it at your next appointment.
  • You must choose your pharmacy carefully. If the transfer arrives and no stock exists, you either have to wait for stock, or pay for another transfer request.
  • Transfers are ONLY done at the days’ end of each Tuesday and Thursday. This means that you MUST wait until the first Wednesday or Friday following your request before inquiring about missing transfers.
  • No exceptions to the conditions above, and no refunds for disappointing outcomes.

     
     

    By submitting this request, I agree that my credit card on file will be charged $28.00 for this transfer and that I will allow the required time for the transfer to be completed before inquiring about missing transfers.