Transfer Form

Patient Details

Tell us about you so that we can verify who you are with your old pharmacy.

Previous Pharmacy Info

Tell us about your old pharmacy so we can transfer your medications

Prescriptions

Add the Rx number for all that you'd like to transfer

Allergies

List any allergies to food, meds, vaccines, latex, etc.

Notes for Pharmacy (optional)

Verify your insurance here or in the pharmacy when you get your medication

How did you hear about us?

Please tell us how you found out about Redding Drug.
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