Transfer Your Prescription to Us

Please fill out the form below to begin the transfer process of your prescription (s) to Bennett’s Route 66 Pharmacy in Claremore, Oklahoma. If you have any issues with the online form, please contact us.

Transfer to Us

Patient Name*
First Last
Patient Date of Birth*
Patient Phone Number*
Email*
Name of Pharmacy Transferring From*
Pharmacy Phone Number (If Available)
Prescription Number or Name of Medication*

Hit the "Plus Button" to add more than one prescription to the transfer form.
Please indicate if you want this prescription kept on record and/or filled immediately*
- Kept on Record
- Filled Immediately
Questions/Comments
Email
This field is for validation purposes and should be left unchanged.