Transfer Form

Tell us about you so that we can verify who you are with your old pharmacy.

First Name *

Last Name *

Phone Number

Birthday *

Address

Country

City

State

Zip code

Tell us about your old pharmacy so we can transfer your medications

Pharmacy Name

Pharmacy Number

Add the Rx number for all that you'd like to transfer

Transfer all of my medications?

Please Enter All Prescriptions Name and Number below

List any allergies to food, meds, vaccines, latex, etc.

List of allergies

Verify your insurance here or in the pharmacy when you get your medication

Questions or Comments

Please tell us how you found out about Redding Drug.

Referall

Captcha *

reCAPTCHA is required.