TRANSFER PRESCRIPTIONS 206 W 6th St. Waynesboro, Ga 30830(706) 558-3400clarkdrug@gmail.com Name * First Name Last Name Date of Birth * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Previous Pharmacy * Medications to Transfer * Entire prescription profile Additional family members Name of Medications Do you need them filled today or put on hold for future fills? Yes No Thank you!
