Pharmacy Transfer Form
Forest Heights Pharmacy 4439 County Club Rd. Statesboro, Ga 30458 Phone: 912.489.7979.
Date of Birth
Street Address Line 2
State / Province
Postal / Zip Code
Please list your current pharmacy:
Do you authorize Forest Heights Pharmacy to contact your current Pharmacy to Transfer your refills?
Upload a copy of your current insurance card (optional)
Drag and drop files here
Choose a file
Please list your current medications you would like transferred: (optional)
Please list additional family members that you would like to have transferred as well: (optional)
Should be Empty:
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