Transfer Your Prescription Over to Fairway Lackner Pharmacy

To transfer your prescription over to Fairway Lackner Pharmacy, simply complete our form below with your information and prescription details. Once you have submitted our form, one of our pharmacy team members will contact your current pharmacy to gather all the necessary information. We’ll then let you know as soon as your prescription is successfully transferred and ready.

What You’ll Need:

Before you begin, please have the following information readily available to help ensure a quick and accurate transfer:
• Your current pharmacy’s name and phone number
• The prescription name or number listed on your medication’s label
• The medication dosage for each prescription you want to transfer

Please fill out the form as accurately as possible to ensure a smooth and timely transfer of your prescription.

    Prescription Transfer Form

    Your Information

    First Name*

    Last Name*

    Phone Number*

    Email Address*

    Date of Birth*

    Pharmacy Information

    Current Pharmacy*

    Pharmacy Phone Number*

    Prescription Information

    Prescriptions to Transfer

    If you have only 'Specific Prescriptions' to transfer, please list them here: