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Refills by Telephone

Contact us toll free 1-866-791-7711 during business with your prescription number.

Refills by Online Form

Please complete the online form for your refill request.

First Name*
Last Name*
Shipping Address*
City*
State*
Zip Code*
Phone Number*
Email Address*
* Required Fields

Informed Consent for Patient Counselling

All patients receiving prescriptions from a Manitoba pharmacy have the right to receive patient counselling. When would be a convenient time for our pharmacist to contact you? Select one below.

Anytime during the day at work.
Anytime during the day at home.
Other. Please specifiy
Please do not contact me as I have taken this medication before and do not wish to receive patient counselling.

Refills Requested

In our continuing efforts to save you money, we will automatically substitute for generic products where applicable unless specifically requested not to.

*Prescription Number
Found on top left corner of prescription label.
*Medication Name
As on prescription label
Brand
Name

*Drug Strength
e.g. 10 mg/ml
*Quantity
Number of tablets capsules, mls, etc.
Yes No
Yes No
Yes No
Yes No
Yes No
I understand that our dispensing pharmacy will fill to the nearest whole bottle quantity when required.
Yes No
Your prescription will be dispensed in Child Resistant Closures unless you decline by indicating "No"
Yes No
Additional Comments For Your Refill


Thank you. The refill order will go for processing and can not be changed or stopped once submitted. Please be sure all information is correct. A representative will contact you only if necessary. Please allow up to 21 days for the delivery of your order.

We will use the payment information that we have in your file. If there has been a change in your payment information, please call our toll free number.
1-866-791-7711



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Toll Free Telephone

1-866-791-7711

Call Center Hours


Toll Free 24 Hour Fax

1-866-791-9911

Available 24 hours a day to fax your order.

 

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