Blue Ridge Pharmacy - Transfer Prescriptions

New to our area or visiting for an extended period? Transfer your prescriptions to us and you will never miss a dosage.

You may transfer up to 6 prescriptions using this form. If you want us to refill any prescription you must answer the refill question indicating YES, otherwise we will place your prescriptions on file for your future use. Please allow additional time for us to contact your previous pharmacy.

(* Required Field)

* Name:

* Address:

* City:

* State:

* Zip:

* Phone:

* Email Address:

Pickup or delivery?

Pickup
Delivery

Please enter all of the digits of your old prescriptions

*	Refill? Yes No
	Refill? Yes No
	Refill? Yes No
	Refill? Yes No
	Refill? Yes No
	Refill? Yes No
	Refill? Yes No
	Refill? Yes No

Prior Pharmacy Information

* Pharmacy Name:

* Address:

* City:

* State:

* Phone:

Additional Notes: