Super Health Pharmacy

First Name

First name

Last Name

Last name

Email

Email Address

Date of birth

Phone number

Phone Number

New Pharmacy location

Select which of our locations you'd like to use

Previous Pharmacy Info

Tell us about your old pharmacy so we can transfer your medications

Pharmacy Name

Pharmacy Phone

Prescriptions

Add the medication name and Rx number for all that you'd like to transfer

Transfer all prescriptions

Notes for Pharmacy (Optional)

Verify your insurance here or in the pharmacy when you get your medication