TRANSFER FORM REQUEST*
Please provide the following information so that we can quickly and most efficiently process your prescription transfer request. If you are not currently a Wausau Family Pharmacy patient please make sure to fill in all information to prevent delays.
Last Name
First Name
Date of Birth
Phone Number
Address
Email
Allergies to Medications?
Pharmacy name where current prescriptions are located
Pharmacy Phone Number
Medications Names/Rx# that need to be transferred/Other requests
Need Medications by (Most transfers do require 48 business hours to process)
Submit