New Patient Form

Use the form below to add or update your patient profile at Lee Drug Store.

If you want to add additional members of your family, please fill a separate form out for each family member.

Your cell phone number and cell phone carrier are required for us to send you text messages when your prescriptions are ready.

**If you need prescriptions transferred to Lee Drug Store, be sure to also fill out the TRANSFER MEDICINE form.**

Click “SUBMIT” after filling in the information.

We send text messages when prescriptions are ready for you.
If yes, please list all allergies

Insurance Information

If you have prescription insurance, select "Yes" below and enter your information. Your card should say RX or prescription, and may be different than your health insurance card. Even if you fill in all of the information below, please bring your card on your first visit.