PRESCRIPTION TRANSFER

TRANSFER YOUR PRESCRIPTION

To transfer your prescription(s) online, please complete the request form below.

First Name:

Last Name:

Date of Birth:

Email:

Phone:

Existing Pharmacy:

If Other Pharmacy, Please Specify Here:

Existing Pharmacy Phone Number:

Prescription(s) to be Transferred to I.D.A. Clair Compounding Pharmacy:

Yes, please transfer all prescriptions to I.D.A. Clair Compounding Pharmacy

No, please transfer the prescription listed below:

Prescription(s) Information:

Thank you for submitting your transfer prescription request. A confirmation email will be sent to you shortly.

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Please try again later.

I.D.A. Clair Compounding Pharmacy

clairpharmacy@gmail.com

FAX: (226) 314 4294