Prescription Refill

Order your prescription refill now using our Rx Refill Form.

Please note: Prescriptions and prescription services are not available for purchase online.

Prescription Refill Form

Complete the form below. It will be sent to our pharmacy staff who will use the information provided to confirm, and refill your prescription for you.

Name(Required)

Date of Birth(Required)

Phone(Required)

Email(Required)

Note: If you do not receive an automated e-mail message within 24-hours to confirm your on-line prescription refill(s) request, please phone 604-533-1041 for personal assistance.

Your Prescriptions

You may include up to six prescriptions.

Instructions

You may include up to six prescriptions.
You must include a Medication Description OR Prescription Number.
If you use a prescription number, please make sure it’s the most recent prescription number.

How Many Prescriptions Would You Like Us To Refill?

Prescription 1

1. Medication Description OR Prescription number

Prescription 2

2. Medication Description OR Prescription number

Prescription 3

3. Medication Description OR Prescription number

Prescription 4

4. Medication Description OR Prescription number

Prescription 5

5. Medication Description OR Prescription number

Prescription 6

6. Medication Description OR Prescription number

Pick Up & Delivery

Select One(Required)

I will pick up my prescription

I would like my prescription delivered. (I understand there may be a reasonable delivery charge).

Prescription Pick-Up Date(Required)

Your Address

Street Address City Postal Code

Special Instructions

Use this field to include any extra details you feel we may need to know when filling your prescription.