Please fill the form below, so we can transfer your prescription

    Please note all fields are required to process your transfer request.

    Existing Pharmacy Information
    1. Pharmacy Name:

    2. Pharmacy Phone Number:

    3. City:

    4. State:

    Prescription(s) Information
    Please give us your prescription information:
    1. First Name:

    2. Last Name:

    3. Date of Birth:

    4. Phone Number:

    5. Email Address (We will send your confirmation to this address):

    Please enter the prescriptions you would like to transfer to our pharmacy:
    If you would like us to transfer all of your medications, please check the box below:
    I would like to transfer all of my medications to Tristar Discount Pharmacy
    1. Medication Name (1):

    2. Medication Name (2):

    3. Medication Name (3):

    You are authorizing the following pharmacy to complete the transfer
    Tristar Discount Pharmacy (Orlando)

    By providing your existing pharmacy information, prescription information, and your contact information, you authorize Tristar Pharmacy or Tristar Discount Pharmacy to contact on your behalf to process your transfer request. You also authorize us to contact you regarding your prescriptions or other questions we may have.
    I agree to use the information I provided to communicate with me and my existing pharmacy to complete my transfer order.

    Please review your information before submitting your request