Transfer a Prescription

Transfer a Prescription

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.
Please Note: If your provider has already submitted your prescription directly to our pharmacy (Transition Pharmacy), or will, please do NOT complete a Prescription Transfer Form.
Patient Name

First NameLast Name
Patient Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Patient Shipping Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Name of Current Pharmacy
Phone Number of Current Pharmacy
Please enter a valid phone number.Format: (000) 000-0000.
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.Format: (000) 000-0000.
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.
Should be Empty: