Register as a new patient We welcome you as a new patient. We’ll need a few details from you, so please fill out the form below to transfer your prescriptions. Your InformationFirst NameLast NameDate of BirthPhonePrevious Pharmacy InformationPharmacy NamePharmacy NumberPrescriptionsTransfer all of my prescriptionsPrescriptions to transferOne per lineNotes for PharmacySubmit infoPlease do not fill in this field.