Prescription Transfer Form
Lindstrom Thrifty White Pharmacy
Street Address Line 2
State / Province
Postal / Zip Code
Date of Birth
Please enter a valid phone number.
Pharmacy name and Phone number of RX being transferred
Prescriptions wanting to be transferred
Medications needed today
Would you like a text message when your order in ready?
Prescription Card Info (May be different than medical Card)
Patient ID Number
You can upload a picture of you insurance card if you would like.
Drag and drop files here
Choose a file
Should be Empty:
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