Transfer Form

Transferring From an Outside Pharmacy

To transfer prescriptions from an outside pharmacy to The Center for Health and Well-Being Pharmacy, please complete this form. Allow 24-48 hours for your prescription to be transferred.

PLEASE NOTE: If you do not wish to transfer all your prescriptions from another pharmacy, please uncheck the "Transfer all of my medications" box below and then list the prescriptions in the fields which appear once the box is unchecked. Please also include your allergies in the “Notes for Pharmacy” field.