Transfer Prescriptions | PharmaHealth Pharmacy New Bedford MA

Welcome to PharmaHealth Pharmacy

Pharmacy Transfer Form

First Name

Last Name

Date of Birth (MM/DD/YYYY)

Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Your Phone Number

Name of Previous Pharmacy

Previous Pharmacy Phone Number

Select

Transfer all of my prescriptions Just transfer the RX(s) that I enter below

Type prescription name or number that you would like us to transfer below

Name of Insurance

Photo of Insurance Card

Notes for the Pharmacy Staff

Signature

Prescription Refill Disclaimer

By submitting this refill request, you acknowledge and agree to the following terms:

Identity Verification & Authorization

I hereby attest and confirm that:

I am the patient for the prescription(s) being requested
The information provided (including date of birth and prescription numbers) is accurate and belongs to me
I am authorized to request this refill
I understand that providing false information is a violation of law and pharmacy policy

No Guarantee of Refill or Timing

Submission of a refill request does not guarantee that your prescription will be refilled, filled by a specific time, or available for pickup/delivery on a specific date.

Verification Required

All refill requests are subject to verification, including:

Valid prescription on file
Prescriber authorization and refill authorization status
Pharmacy review for clinical appropriateness
Insurance eligibility and approval
Patient identity and date of birth verification

Not for Urgent or Emergency Needs

This refill request tool is for routine refills only. If you require immediate assistance, contact the pharmacy directly or seek medical care.

Processing Times

Refill requests received outside normal business hours will be processed on the next business day. PharmaHealth Pharmacy is not responsible for delays caused by prescriber response times, insurance authorization, supply shortages, or incomplete information.

Authorization to Access Records

By submitting this request, you authorize the pharmacy to access and review your prescription, medication, and insurance records as necessary to process the refill.

Privacy and Data Security

Information submitted is processed in accordance with applicable privacy laws and our Privacy Policy.

Independence of Professional Judgment

A licensed pharmacist may refuse to refill a prescription if, in their professional judgment, it would be unsafe or inappropriate to do so.

I confirm that I have read and agree to the terms above and that I am the patient associated with this request.