New Patients

Welcome New Patients to Hart Family Pharmacy in Graham, WA

We are thrilled to welcome you to Hart Family Pharmacy!

Our mission is to provide personalized and comprehensive healthcare services to our community.

To ensure a smooth and efficient first visit, please complete the new patient form below. This will help us gather essential information about your health and medication needs.

Patient Details:

We will need to confirm these details and your identity with your old pharmacy.

First Name

Last Name

Primary Phone Number

Email Address

Date of Birth

Notification Preference

Previous Pharmacy Information:

We will contact your original pharmacy to transfer your prescriptions.

Previous Pharmacy Name

Previous Pharmacy Phone Number

Prescription Details

Please enter the name of any medication(s) you would like transferred. If you know the prescribing doctor, please leave that information too.

Verify your insurance here or in the pharmacy when you collect your medication.

By checking this box, I give my informed consent to the collection, storage, and processing of my personal and health data as described in the Privacy Policy & Notice of Privacy Practices. I understand that I can withdraw my consent at any time.

I understand I may be contacted to provide additional information or to attend a consultation.

See the links in our website footer at the bottom of this page for further information.

Please correct the errors above and try again.