Transferir recetas | A&A Family Pharmacy

How it works

Or request a transfer online

Submit request
Pharmacist reviews
We contact your pharmacy
Prescription ready

Before you begin

This form sends a request only. It does not guarantee a transfer.
A licensed pharmacist will verify your information and contact your current pharmacy directly.
By submitting, you authorize A&A Family Pharmacy to contact your current pharmacy to request transfer of the prescription(s) listed.

Indicates a required field.

Patient information

First name

Last name

Date of birth

Phone

Email (recommended)

Current pharmacy

Pharmacy name

Pharmacy phone

Street address

City

State

ZIP

Medications

List each medication by name. Do not include dosage, quantity, or RX numbers.

Medication 1

Additional notes (optional)

0/500

Authorization and acknowledgmentI am the patient or an authorized representative. I certify that the information I am submitting is true and complete, and I authorize A&A Family Pharmacy to contact my prior pharmacy and prescriber to request the transfer and, if needed, new authorization for the medications listed. I understand I may be contacted by phone, email, or text about this request. I have read the Notice of Privacy Practices and the Prescription Transfer Service Terms. I understand this is not an emergency service — if I need medication urgently, I will call the pharmacy at (954) 987-5230 or 911.I have reviewed all transfer details above and confirm they are correct before submission.