Transfer A Prescription

Transfer Request - AvitaCare Atlanta - Formstack

Your Name*

First Name

Last Name

Phone*

Email*

Birthdate

What is your current pharmacy?*

What's their phone number?*

What's your prescribing doctor's name?*

Do you receive care at a healthcare center or community clinic? If so, what's the name?

Transfer All My Prescriptions

RX Numbers of Prescriptions to Transfer

Please type one on each line

Address:
2140 Peachtree Rd Ste 232
Atlanta, GA 30309

Hours of operation:
M-F, 7:30AM – 5:30PM

Clinic phone number:
404.231.4431

Clinic fax:
404.231.5677

Pharmacy phone number:
800.765.0731