Appointment

Transferring your scripts to Westside Pharmacy is simple. Please fill out required fields below to start getting the services you deserve.

* Required Information

FULL NAME *

ADDRESS *

City *

STATE

ZIP *

EMAIL ADDRESS *

PHONE NUMBER

EZ OPEN CAPS?

Yes

REFILL MAINTENANCE MEDICATIONS EACH MONTH?

Yes

DRUG ALLERGY?

Yes

Current Medications/Prescription Numbers (including over-the-counter and herbal)

Enter current medication-3

Enter current medication-4

LIST MEDICAL CONDITIONS

Previous Pharmacy Name

Previous Pharmacy Phone Number

Opt-In

I consent to receive text messages about refill reminders, account notification and any relevent information from WestSide Pharmacy at the phone number I provided. I acknowledge that my consent is not a condition of purchase. Msg & data rates may apply. MSG frequency varies. Reply HELP for assistance or STOP to opt out of receiving messages. Privacy Policy & Terms.

Opt-In

I consent to receive marketing text messages, such as Promotional offers, Discounts and Sales Events from WestSide Pharmacy at the phone number I provided, including messages sent via auto dialer. I understand that my consent is not a condition of purchase. Msg & data rates may apply. Msg frequency varies. Reply HELP for assistance or STOP to opt out of receiving messages. Privacy Policy & Terms.