New Patients

It's easy to become a patient at our Pharmacy!

Please fill out the registration form below to get started. We're excited to provide you with personalized healthcare services.

Your Name

Patient Details:

We will need to confirm these details and the patient's identity with their old pharmacy.

Patient's Full Name

Please enter the patient's full name if you are filling in this form for another person

Primary Phone Number

Email Address

Date of Birth

Preferred Notification Method

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.

Which Stokes Pharmacy location are you transferring to?

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.

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

Please correct the errors above and try again.

Stokes Pharmacy

Stokes and Broad Street Pharmacies are proud members of the King, Danbury and Rural Hall communities. We are an independent pharmacy with intentions of providing our patients with great customer service at an affordable price.

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North Carolina , United States

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