Transfer Prescriptions

New to our area or visiting for an extended period? Transfer your prescriptions to us and you will never miss a dosage.
You may transfer up to 6 prescriptions using this form. If you want us to refill any prescription you must answer the refill question indicating YES, otherwise we will place your prescriptions on file for your future use. Please allow additional time for us to contact your previous pharmacy.
To: pharmacist@weavervilledrug.com

Name:	*
Address:	*
City/ State/Zip:	*
Telephone:	*
E-Mail Address:	*
(Please enter all the digits of your old prescription(s). Refill? Refill? 1st Rx #: * No Yes 2nd Rx #: No Yes 3rd Rx #: No Yes 4th Rx #: No Yes 5th Rx #: No Yes 6th Rx #: No Yes
Prior Pharmacy Information
Pharmacy Name	*
Address
City/State
Telephone	*
Comments:
or