Prescription Transfer
Transfer prescriptions to Better Health Pharmacy and experience the difference in our service.
Information About Your Current Pharmacy
Your Current Pharmacy's Name
*
CVS
Walgreens
Walmart
Kroger
Costco
Other
Phone Number of Pharmacy Transferring From
Please enter a valid phone number.
Format: (000) 000-0000.
Enter Your Prescription Information
Patient Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Patient Date of Birth
*
-
Month
-
Day
Year
Date
I would like to transfer my whole profile to Better Health Pharmacy
*
Yes
No
Medication 1
Medication 2 (Optional)
Medication 3 (Optional)
How Can We Reach You?
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: