Forms & Information - The Chemist Pharm

Pharmacy Services

Prescription Refill Request

Please complete this form to request a refill of your existing prescription.

Name

Date of Birth

Phone Number

Email Address

Prescription Number

Medication Name

Prescribing Doctor

Additional Notes (Optional)

Preferred Pickup/Delivery

Got Questions?

Our pharmacy team is here to help. Contact us at (281) 969-7346 or email us at tcp@thechemistpharm.com for assistance with your refill request.

Make the Switch to The Chemist Pharmacy—Easily and Seamlessly

If you’re looking to transfer your prescription to The Chemist Pharmacy, we’d love to welcome you! Our team makes the process quick, easy, and stress-free—so you can focus on your health, not the paperwork.

How It Works

Call us at (281) 969-7346 and let us know you’d like to transfer a prescription.
Our pharmacist will contact your provider or current pharmacy to handle the transfer.
Or, fill out our New Patient Form and we’ll reach out with next steps.

New Clinic Registration

Please complete this form to register your clinic.

Clinic Contact Name

Clinic/Practice Name

Role at Clinic

Phone Number

Office Fax (Optional)

Clinic Address

City

State

Zip Code

Clinic Website (If Applicable)

Clinic Specialty

Additional Comments or Requests (Optional)

Got Questions?

Our pharmacy team is here to help. Contact us at (281) 969-7346 or email us at tcp@thechemistpharm.com for assistance with your refill request.

New Patient Form

Please take a moment to fill out the form.

Name

Date of Birth

Phone Number

Email Address

Gender

House Address

State

Zip Code

City

Allergies & Sensitivities

Additional Notes (Optional)

Got Questions?

Our pharmacy team is here to help. Contact us at (281) 969-7346 or email us at tcp@thechemistpharm.com for assistance with your refill request.