Canada Drugs Reorder Form
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Canada Drugs Reorder Form

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Order By Mail ...

Order By Mail

1. Download and print order form(s) (PDF format)

2. Find your drugs using the Drug Search or OTC Drug Search

3. Record drugs and prices on your order form(s) and fill out all required information

4. Mail order form(s) and your original prescription(s) to:
Order By Phone

1. Call now toll free 1-800-267-2688 to place a phone order 24hours a day 7 days a week.

We have skilled Patient Service Representatives (PSR) standing by in our call center. If you reach us outside of business hours, please leave your name and contact phone number on our answering service and a PSR will contact you the next business day.

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  • 1. Form 2 Patient Information Patient Name: Date of Birth: Gender:  M   F Address: City State Zip Phone: (day) Phone: (eve) Email Address: Affiliate Code Medical Information Medical information needs to be submitted only on the first order or if medical condition changes. Known Drug Allergies Doctors Name, Address and Phone Number Current Medications Check box if you do not want child proof caps Medications Used in Past 12 Months Signature Date Order/Reorder Information Important: Please make money orders payable to: Promo Code NEW PATIENT  or EXISTING PATIENT REORDER Payment Method Visa       Master Card       Money Order       Personal Check Credit Card # Expiry Date Name CVV Code (as it appears on check/card) Signature Date STRENGTH QUANTITY PRICE REQUESTED MEDICATION REQUESTED (U.S. DOLLARS) Brand Generics only permitted Subtotal $ Toll-Free Phone: 1-800-267-2688 Shipping $ 9.95 Order Processing Center Toll-Free Fax: 1-800-563-3822 210-900 St. James Street Email: TOTAL (U.S. Dollars) $ Winnipeg, MB R3G 3J7 REFERRED BY Full Name Phone Complete to receive $10 off for yourself and the person who referred you.