Transfer to Foothills Pharmacy

Transfer Your Prescriptions

Transferring prescriptions to Foothills Pharmacy is easy! Fill out the form below or give us a call at 828-894-6112! Welcome to the Foothills Pharmacy family!
Name

First Name Last Name
Date of Birth

Month Day Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Current Pharmacy Name
Current Pharmacy Phone Number
Please enter a valid phone number.
Please name the prescriptions you want to transfer to Foothill's Pharmacy. (You can type "All" if you don't want to list each medication name)
Upload Scan of Insurance Card

Cancel of
*If you chose not to upload your insurance information, please bring your insurance card during your first visit.
Check this box if you would like all your medications to be synchronized to be picked up at the same day each month.
Should be Empty:

Transfer Your Prescriptions