Transfer Prescriptions

Patient Information

(Name must be entered exactly as it appears on the Prescription Label)

Transferring Pharmacy Location

Prescriptions to be Transferred

Please provide us with drug name or prescription number for each of the prescriptions you would like to transfer to Fanshawe College Pharmacy.

Fill my prescription(s) as soon as the prescription transfer is complete.Hold prescription(s) until I request a refill.

Important Note

Fanshawe College Pharmacy is committed to protecting the privacy of our customer's information. Any and all information provided on this form will be kept strictly confidential in accordance with our privacy policy.

By submitting this form you are giving consent for a Fanshawe College Pharmacy representative to contact the transferring pharmacy indicated to complete your prescription transfer request.

Please review your request before submitting.