Transfer Patient - Westside Pharmacy

Transferring your scripts to Westside Pharmacy is simple. Please fill out required fields below to start getting the services you deserve.

Full Name

Address

City

State

ZIP

Email Address

Phone Number

EZ OPEN CAPS?

Yes No

Refill Maintenance Medications each Month?

Yes No

Drug Allergy?

Yes No

Current Medications / Prescription Numbers (including over-the-counter and herbal)

List Medical Condiitons

Previous Pharmacy Name

Previous Pharmacy Phone Number

I consent to receive text messages about refill reminders, account notification and any relevent information from WestSide Pharmacy at the phone number I provided. I acknowledge that my consent is not a condition of purchase. Msg & data rates may apply. MSG frequency varies. Reply HELP for assistance or STOP to opt out of receiving messages. Privacy Policy & Terms.

I consent to receive marketing text messages, such as Promotional offers, Discounts and Sales Events from WestSide Pharmacy at the phone number I provided, including messages sent via auto dialer. I understand that my consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Reply HELP for assistance or STOP to opt out of receiving messages. Privacy Policy & Terms.