Transfer a Prescription

Transfer a Prescription

Please note that you may be contacted by a Transition Pharmacy representative to help facilitate and finalize the transfer of your prescription. Separately you will need to enroll in The HRT Club to begin receiving your prescriptions.
Patient Name*

First NameLast Name
Patient Phone Number*
Please enter a valid phone number.
Patient Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Date of Birth*

MonthDayYear
Date
Name of Current Pharmacy*
Phone Number of Current Pharmacy*
Please enter a valid phone number.
Address of Current Pharmacy

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Prescribing Doctor*

First NameLast Name
Prescribing Doctor's Phone Number*
Please enter a valid phone number.
Name and Strength of Medication(s) to Transfer (Please note we cannot initiate a transfer without this information.)*
IMPORTANT: We cannot accept transfer requests for controlled medications including testosterone. Please have your healthcare provider submit a prescription directly to Transition Pharmacy.
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