Refill My Prescription

Name

First Name

Last Name

Email address

Your phone number

(###)

###

####

Which prescriptions can we refill for you?

Please list all prescription numbers or medication names that you would like to transfer or refill separated by a comma.

How soon do you need your medication?

Which location has your prescription?

KINGSWAY Canadian Compounding Pharmacy

HIGH PARK Pharmacy

JUNCTION Pharmacy

Which would you prefer?

Pick-up

Curbside pick-up

Free Delivery * on all compounded prescriptions AND all local deliveries - ask for details

Would you like a call when your order is ready?

Additional comments (you are welcome to add any other pharmacy items below)