top of page

Prescription Transfer Form

First name*

Last name*

Email*

Date of Birth MM/DD/YYYY*

Phone*

Please fill out the information for the Pharmacy we're transferring from below.

Pharmacy Name*

Pharmacy Phone Number*

Please Select One*

Transfer all my prescriptions

Only transfer my selected prescriptions:

If selected prescriptions only please write prescription number or drug name:

I consent to sending this information to Urban Drug Mart.

I understand that some prescriptions cannot be transferred. In that case the pharmacist will contact you.

© 2023 by Urban Drug Mart. All Rights Reserved.

Address

Unit #150 - 20385

64 Avenue, Langley

BC, V2Y 1N5

Navigate

Prescription Transfers

Hours

Monday - Saturday: 7:00am – 7:30pm Sunday: 7:00am – 4:30pm

Home
About
Services
Contact
Prescription Transfer

bottom of page