Skip to main content
  • WE ARE OPEN MONDAY-SATURDAY AT 9:00 AM
Transfer My Prescription
Refill My Prescription
Home

Main navigation

  • ABOUT US
    • Discover Our Difference
    • Employment Application
  • PRESCRIPTIONS
    • New Prescriptions
    • Refill Prescriptions
    • Transfer Prescription
    • Free Prescription Delivery
    • Refill Prescriptions On Your Mobile Device
  • PHARMACY SERVICES
    • Prescription Synchronization
    • Diabetes Care
    • Drug Interaction Screening
    • Medication Packaging With Dispill Pack
    • Medication Therapy Management
    • Pharmacy Counseling
  • PROGRAMS
    • Trust Your Meds Program
    • Wallet Care Program
  • Blog
  • PROVIDERS
    • Physician Support
      • Physician Rx Form
    • Payor Support
    • Residential Care Services
    • Automated Dispensing Technology
  • MY KIDS CAMP MEDS
    • Camper Medication Form
    • Physician Instructions
    • Terms Of Use and FAQ
    • Other Forms
      • My Camper's Medication Has Changed Form
      • My Insurance Has Changed Form
  • CONTACT
    • HOLIDAY CLOSURES

My Camper's Medication Has Changed Form

If your Camper's medication has changed, please submit this form. Complete a separate form for each camper. If you have any questions, call us at (951) 407-0707

LIST ALL the medications your camper will be taking at camp, since this form will invalidate the previous form you submitted. In this form, you will also have the option to enter insurance information if your insurance has changed. Make sure either you, or your physician send all prescriptions to Perris Hills Pharmacy.

Download the PDF version of My Camper's Medication Has Changed here.

PARENT OR LEGAL GUARDIAN INFO
MY CAMPER'S INFO

The information of the child going to camp

MY CAMPER'S MEDICATIONS

Please list all medications (prescription, OTC, vitamins and supplements) that the camper is currently prescribed or is taking. Make sure you review your camper's Rx with your physician to confirm it is written exactly the way your camper takes the medication before sending to Perris Hills Pharmacy. We understand that this list might change as we approach camp season.

MEDICATIONS PRESCRIBED BY: Primary Physician

MEDICATIONS PRESCRIBED BY: Primary Physician
Enter all medications prescribed by your child's primary physician.

Medication 1
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 2
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 3
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 4
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 5
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 6
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 7
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 8
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 9
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 10
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
MEDICATIONS PRESCRIBED BY: Other

MEDICATIONS PRESCRIBED BY: Other Physicians
Enter all medications prescribed by other physicians (that are not your child's primary physician). Make sure to add Physician's first name, last name, phone number and fax for each medication

Medication 1
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 2
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 3
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 4
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 5
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 6
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 7
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 8
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 9
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
Medication 10
Breakfast, Lunch, Dinner, Bedtime or As Needed/PRN
SPECIAL INSTRUCTIONS
INSURANCE INFORMATION
Primary Insurance
Secondary insurance

A G R E E M E N T  
By clicking "Submit" you agree to Perris Hills Pharmacy's, My Kids Camp Meds TERMS OF USE and PRIVACY POLICY AGREEMENT.

My Kids Camp Meds

  • My Kids Camp Meds
  • Camper Medication Form
  • Physician Instructions
  • Terms Of Use and FAQ
  • My Camper's Medication Has Changed Form
  • My Insurance Has Changed Form
Let the kids be kids and we will take care of their medications
Logo My Kids Camp Meds
logo Perris Hills Pharmacy
(951) 407-0707 Need Assistance? Call Us Now:

About Us

Welcome to Perris Hills Pharmacy, your full-service pharmacy serving individuals with complex health conditions and those facing temporary health challenges. At Perris Hills Pharmacy, we embrace a 'Taking Care of People First' philosophy, prioritizing the well-being, health, and satisfaction of patients and customers above all else.

Wondering how we can assist you? Call or visit us for personalized care and options tailored to your needs.

EN NUESTRA FARMACIA, HABLAMOS ESPAÑOL.

Download App

Refill Prescriptions Over Your Mobile Device

Google pay button


Download the Refill Prescription App on Apple


Legal & Accessibility

• Notice of Privacy Practices

• Terms of Use

• Notice of Non-Discrimination

• Language Assistance

Pharmacy Services

Pharmacy Services

  • Prescription Synchronization
  • Diabetes Care
  • Drug Interaction Screening
  • Medication Packaging
  • Medication Therapy Management
  • Pharmacy Counseling

Follow Us

Get in Touch

  • 524 W 4th Street, Suite A, 
    Perris, CA 92570

  • Phone: (951) 407-0707

  • Fax: (951) 657-5481

  • Email@PerrisHillsPharmacy.com


My Kids Camp Meds

  • Phone: (951) 407-0707

  • Fax: 1 (844) 856-8900

  • Camp@PerrisHillsPharmacy.com


Working Hours

Monday - Friday: 9.00 am - 6.00 pm

Saturday: 9:00 am - 1:00 pm

Closed on Sundays and Holidays

© 2024. All Rights Reserved. Perris Hills Pharmacy, Perris, CA