One short form

Transfer your prescriptions

Tell us what to move — we’ll contact your current pharmacy and get you set up at Staywell.

Request a transfer

Opens your email app with a ready-to-send message to contactus@mystaywellpharmacy.com. No third-party form service.

Patient full name

Date of birth

Mobile phone

Email (optional)

Current pharmacy name

Current pharmacy phone (optional)

Medications / Rx numbers to transfer

Notes (optional)

I authorize Staywell Pharmacy to contact my current pharmacy to transfer these prescriptions.