Fairmont Prescription Transfer Form
Transferring your medications to Sterling is a simple process. Give our store a call at 507-238-2797, or fill out the information below.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Birth Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Pharmacy Name
*
Current Pharmacy Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Choose an option:
*
Transfer All Prescriptions
Transfer Individual Prescriptions
Rx Number/Medication Name/Dosage
*
Message to Pharmacist
Please verify that you are human
*
Submit
Should be Empty: