Transfer Prescriptions

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Transfer Prescriptions using Request From

Transferring your prescriptions to Western On-Campus Pharmacy is simple and easy, whether it is from another pharmacy or between University Pharmacy locations.

Complete the form below to transfer your 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 Western On-Campus Pharmacy.

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

Important Note

Western On-Campus Pharmacy is committed to protecting the privacy of our customers' 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 Western On-Campus Pharmacy representative to contact the transferring pharmacy indicated to complete your prescription transfer request.

Please review your request before submitting.