HELP US HELP YOU

Please fill out the form below and it will automatically send us the email and we will update your information in our new computer system

WE THANK YOU

Please Fill Out This Form

To enhance our service to you, Haller's Pharmacy is upgrading our computer system, effective Tuesday, June 24, 2025. This new system will improve efficiency and patient experience, but the transition may cause minor delays. We kindly ask for your patience during this period. Please visit our website, linked below, to update your personal information ahead of the change to ensure a smooth transition.

*When you come in for your first prescription we will make sure we have all the correct info and update any necessary information.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Please provide any special instructions