Prescription Transfer

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Corner Drugs wants to be your pharmacy.  If you would like to transfer your prescriptions to us, just fill out the form and we will take it from there.  Please include contact numbers in case we have questions for you.  Not all fields are required, but please make sure that we have the proper information to serve you best.  If you wish to transfer more than one prescription, please enter the information for each one.  Thanks!

Prescription Tranfer Form

Patient's Name

Patient's Home Phone

Patient's Cell Phone

Patient's Work Phone

Patient's Address

City

State

Zip Code

First Prescription

Pharmacy Name

Pharmacy Phone Number

Prescription Number

Medication Name

Medication Strength

Medication Quantity

Prescribing Physician

Second Prescription

Pharmacy Name

Pharmacy Phone Number

Prescription Number

Medication Name

Medication Strength

Medication Quantity

Prescribing Physician

Third Prescription

Pharmacy Name

Pharmacy Phone Number

Prescription Number

Medication Name

Medication Strength

Medication Quantity

Prescribing Physician

Please type in Value

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Corner Boutique

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APP LOGOThe official Corner Drugs iPhone app, you can order your refill prescriptions from your Apple iPhone. Simply enter your prescription number, first and last name, and phone number - then click the refill button. And to save your personal information for easier use each time you want to refill a prescription, you can create a user profile using a secure login.