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Fill A New Prescription

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Fill A New PrescriptionJosef Stevens2023-12-07T08:26:48-05:00
1Terms & Conditions
2Your Information
3Prescription(s)

Terms and Conditions

1. To fill new prescription(s) you will need to upload a picture of the prescription(s). Make sure to capture the entire page(s) in your pictures. If there is information on the back of the prescription(s) you will need to have photos of the back as well.

2. Please keep the original prescription to give it to your delivery driver or give it to the pharmacist if you are picking up meditations. I understand that Ontario law requires the pharmacy maintain the original prescription. I agree to keep the original prescription safe and unaltered in any way until it can be picked up by the pharmacy.

3. Your request will be processed during normal pharmacy hours.

If you have any questions do not hesitate to contact us.

By submitting this form, I am consenting to the collection and use of my personal information for the purpose of submitting my prescription to be filled by the Pharmacy I have selected. I understand that my prescription and personal information will reside at the pharmacy I have chosen.

Untitled(Required)

About You

Your Name(Required)
Date of Birth(Required)
Your Address

How Can We Reach You?

Please provide contact information in case we need to reach you concerning your prescription.

Additional Notes

Do not provide any personal health, billing or credit card information.

Upload Your Prescription(s)

Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 4 MB, Max. files: 10.
    Only required if there is information on the back of the prescription.
    Drop files here or
    Accepted file types: jpg, png, pdf, Max. file size: 4 MB, Max. files: 10.
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