New Patient Form

Tell us about you so that we can verify who you are with your old pharmacy.

First Name *

Last Name *

Phone Number

Birthday *

Address

Country

City

State

Zip code

List any allergies to food, meds, vaccines, latex, etc.

List of allergies

Verify your insurance here or in the pharmacy when you get your medication

Questions or Comments

Please tell us how you found out about Redding Drug.

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