Skylands Community Pharmacy
Eighty Main Plaza
Hackettstown, NJ 07825
908-852-DRUG (3784)
FAX 908-684-3232		   Patient Registration

Stop by our store for your FREE gift just for filling out this form and dropping it off in our NEW store. Hope to see you there!

In order to streamline the process of transferring you and your family's prescriptions to our pharmacy, please fill out the questionnaire below. In addition we will also need a copy of your prescription insurance card (if you have one) BOTH front and back.

You may FAX this back to us at 908-684-3232, or mail it back to us at the above address or stop in the week of October 7th and drop it off to us in person. We anticipate the store opening on or about October 14th, and the pharmacy on or about October 28th, dependent on issuance of the appropriate pharmacy licenses by the State and Federal governments.
Viewing the registration form requires the Adobe Acrobat reader. This reader is a simple download and freely available from Adobe. Click on the download link below to get the Acrobat Reader.
 
Click here to view the registration form.
Click here to get the Adobe Acrobat reader.
 
Home Health Care Registration Form