Cabinet Transfer Prescription Form

Transfer your prescriptions

Let us know which medications you take and we can transfer them from your old pharmacy.
What prescription(s) would you like to transfer? See the reference below for where to find your medicine's name on its bottle.*
What prescription(s) would you like to transfer? See the reference below for where to find your medicine's name on its bottle*
The name and dosage of your medicine might look like this on your medicine bottle label.
By selecting the box below, I authorize the use and disclosure of my Information in accordance with Cabinet's Patient Authorization for Use and Disclosure of Protected Health Information.*

I agree
You can read the full Patient Authorization for Use and Disclosure of Protected Health Information at cabinethealth.com/pages/patient-authorization.

*By selecting the box on behalf of the patient, as representative or guardian, I attest that I am legally able to sign such documents on the patient’s behalf and am properly acting in my capacity in doing so. Proof of such guardian’s or representative’s authority to act for the patient may be requested such as power of attorney or legal court order.

What's your old pharmacy?

Let us know your old pharmacy's contact info so we can get your prescriptions transferred.
Pharmacy Name*
Pharmacy Phone Number*
Please enter a valid phone number.
Pharmacy Zip Code

Your pharmacist wants to know

In order to complete your transfer, we need a little bit more info about you.
Take Photo of Photo ID
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Birth Sex*

FemaleMaleIntersex
Do you have any allergies?*
What allergies do you have?*
Do you have any medical conditions?*
What medical conditions do you have?*
Are you taking any other medication?*
What other medications are you taking?*

Almost done! Let us know how we should contact you when your prescription is ready
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
By checking this box, I agree to receive SMS notifications from Cabinet about my prescription(s)*

I agree
Please verify that you are human*
Should be Empty:

Transfer your prescriptions