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Prescription Transfer

We make Transferring your prescription to Klingensmith a fairly simple process! For your convenience, you can Call Us, Stop In, or Fill Out The Form below.

OPTION 1 CALL OR STOP IN

If you prefer, you can give us a call or stop in at any one of our locations to speak to one of our pharmacists. – Be prepared: You’ll need to have the Prescription Name, Strength, and RX number of each prescription, Also, you’ll need the Phone number and Address of your old pharmacy.

Find the location that works best for you: OUR LOCATIONS

OPTION 2 FILL OUT THE FORM

PATIENT’S INFORMATION

First Name*

Last Name*

Phone Number*

Email*

Date of Birth*

Street Address*

Street Address Line 2

City, State / Province*

Postal / Zip Code*

CURRENT PHARMACY

Name of existing pharmacy*:

Address

City, State Zipcode

Phone Number*

PRESCRIPTION INFORMATION

Please list the prescription to be transferred

RX1 Name

RX1 Number

RX1 Dosage

RX2 Name

RX2 Number

RX2 Dosage

RX3 Name

RX3 Number

RX3 Dosage

RX4 Name

RX4 Number

RX4 Dosage

RX5 Name

RX5 Number

RX5 Dosage

SELECT ONE OF OUR LOCATIONS

Select One Of Our Locations *

COMMENTS FOR OUR PHARMACY

Please write your comments here...

AGREEMENT *

Agreement

By providing your phone number and email address, you authorize us to contact you in connection with pharmacy services, health care, and your account via text or live and autodialed calls at the phone number provided above. Your consent is not a condition of purchase or receipt of services and may be revoked at any time. Your carrier’s message and data rates apply.

Prescription Transfer

OPTION 1 CALL OR STOP IN

OPTION 2 FILL OUT THE FORM

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