Transfer Prescriptionbook — Lagom Rx

Transfer for a $10 Lagom gift card!

Your Name *

Your Name

First Name

Last Name

Email Address

Your Phone *

Your Phone

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Drug Name(s) or Prescription Number(s)

seperate with comma for best service

Pharmacy Name *

Town/street can help us. Walgreens on Halsted for example

Pharmacy Phone Number

If you do not have it we'll find it

Would you like us to text you when your prescription is ready?

Yes

No

Should we transfer all your prescriptions?

Yes

No