Transfer a Prescription

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Remember, we’re not yet accepting all insurances.
Check our homepage for currently accepted insurances.

We’re here to help! If you have questions or concerns,
please call us at 206-385-6552.

"*" indicates required fields

Name*

First Last

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Enter Email Confirm Email

Mobile Phone Number*

What best describes your gender?*

Female

Male

Prefer not to say

Is your gender the same sex you were given at birth?*

Yes

No

Prefer not to say

Allergies*

If no allergies type “none”.

Medical Conditions*

If no medical conditions type “none”.

Preferences*

Easy Open

Visually Impaired

Hearing Impaired

Do not phone

None of the above

I Agree*

The contact information provided will not be shared and will only be used to contact you regarding your prescriptions. *

Transferring Pharmacy Information

What is the name of the pharmacy from which you wish to transfer your prescription?*

Phone*

Pharmacy Address*

Street Address Address Line 2 City State ZIP Code

Prescription Information

Please choose one of the following:

I want to enter medications by name

Skip to profile transfer request

You have chosen the option to transfer all the prescriptions with refills available. When received, they will all be placed on file unless you indicate in the notes section that you need something prepared. Please call in advance so we have time to contact the prescriber or order the item if needed. (Providing a list of medications is highly suggested to make sure all the prescriptions are transferred successfully.) *

Medication #1 Name and Strength*

If you do not have any refills remaining at your prior pharmacy please contact you prescriber to send us a new order.

How would you like us to proceed once this prescription is transferred to our pharmacy?*

Prepare the medication

Place it on file and I will request it when needed

Please choose one of the following*

I want to enter another medication for transfer

I’m all done

Medication #2 Name and Strength

If you do not have any refills remaining at your prior pharmacy please contact you prescriber to send us a new order.

How would you like us to proceed once this prescription is transferred to our pharmacy?

Prepare the medication

Place it on file and I will request it when needed

Please choose one of the following

I want to enter another medication for transfer

I’m all done

Medication #3 Name and Strength*

If you do not have any refills remaining at your prior pharmacy please contact you prescriber to send us a new order.

How would you like us to proceed once this prescription is transferred to our pharmacy?

Prepare the medication

Place it on file and I will request it when needed

Please choose one of the following

I want to enter another medication for transfer

I’m all done

Medication #4 Name and Strength*

If you do not have any refills remaining at your prior pharmacy please contact you prescriber to send us a new order.

How would you like us to proceed once this prescription is transferred to our pharmacy?

Prepare the medication

Place it on file and I will request it when needed

Please choose one of the following

I want to enter another medication for transfer

I’m all done

Medication #5 Name

If you do not have any refills remaining at your prior pharmacy please contact you prescriber to send us a new order.

How would you like us to proceed once this prescription is transferred to our pharmacy?

Prepare the medication

Place it on file and I will request it when needed

Should We Contact You?

When your prescriptions are ready, how would you like to be notified?*

Text Me

Call Me

No need to notify me

Anything else you'd like to tell our staff?*

If you have nothing else to tell us please type “none”.

Comments

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Contact Us

Phone: 206-385-6552
Fax: 206-385-6255
Text: 206-385-1870

Address:
1815 N. 45th St. Suite 110
Seattle, WA 98103

Hours:
Monday – Friday: 9 am – 6 pm
Saturday: 10 am – 5 pm
Sunday: Closed

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