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Prescription Transfer Form
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Prescription Transfer Form
Please enable JavaScript in your browser to complete this form.
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Email
*
Current Address
Current Pharmacy
*
prescriptions List you'd
Current Pharmacy's Phone Number
*
(000) 000-0000
List the prescriptions you would like to transfer to our pharmacy. Type "ALL" if you'd like a full transfer.
Communication Preferences
*
By checking this box, I consent to receive conversational, marketing, and customer care SMS from MedsPLUS Pharmacy & Wellness Center. Reply STOP to opt-out; Reply HELP for support; Message & data rates may apply; Messaging frequency may vary. Visit
Privacy Policy
to see our privacy policy and
Terms
for our Terms of Service.
By providing your phone number, you consent to receive text messages (including automated messages) from MedsPLUS regarding your account, services, and updates relevant to you. For full details on how we collect, use, and protect your information, please review our Terms and Conditions and Privacy Policy found below the submit button.
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