Dougherty's Pharmacy - Online Prescription Form - Dallas, Texas, reorder prescriptions, transfer prescriptions, Rx

Dougherty's Pharmacy Logo

Reorder or Transfer
your current prescriptions

Billing Address:

Name:
E-mail :

Address:
City: State: Zip:
Day Phone:
Evening Phone:

Shipping Address(if different from above):

Name:
Address:
City: State: Zip:

Drug Allergies:

RX:
RX:
RX:
RX:
O.T.C.:
O.T.C.:

For Transfers, please provide the following information:

Pharmacy name:

Pharmacy phone number:

Delivery Options:

*Rush orders require a special handling fee

Payment Method:

(Name on Card):
(charge #):
Exp:

Comments or Questions: