New Patients

Welcome to Rocky Mountain Pharmacy your local, full-service pharmacy with a diabetes specialty. We look forward to serving your pharmaceutical needs with exceptional service!

To get started, simply bring your prescription into our pharmacy and we’ll fill the order in person. You may also call us at 208-528-9658 or save time by filling out the form below.

New Patient Form

Patient Info

First Name

Last Name

Phone

Birthday

Alternate Contact Name

Alternate Phone

Address

Street Address Line 1

Street Address Line 2

City

State/Province

Zip/Postal

Allergies

Optional Prescription Information

Transfer Prescriptions

Medication Name and Strength

Prescription Number

Add Another Medication

Previous Pharmacy Name

Previous Pharmacy Phone

Message to our Pharmacist

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