Transfer Prescription

Click "Next" Below

Personal Info

Are you a new patient or an existing patient? *

Patient First Name *

Patient Last Name *

Date of birth *

Phone *

Email *

Postal code *

- Please provide as much information about the pharmacy that has your prescription. -

Name of Pharmacy *

Address / Intersection of Pharmacy *

Phone Number of Pharmacy

Would you like to transfer all your prescriptions? *

Please transfer the following prescription(s) only: *

Would you like us to prepare your prescription(s) now? *

Please prepare the following prescription(s) now: *

I prefer *