Transfer Form Start your prescriptions transfer now Fill in the form below to get started ... Name* Email* Your Phone Number* Current Pharmacy Name* Current Pharmacy Phone Number* Prescription #1* Prescription #2 Prescription #3 Prescription #4 Prescription #5 Notes / Instructions(optional) (2000 chars left) Validate Form > submit Thank you for your transfer request. Your request has been received. We'll get back to you as soon as possible. MedValt Pharmacy. Please turn on javascript to submit your data. Thank you!