Existing Patient Mail / Fax Order Form

Fax to: 1-888-536-8192

Or mail to:

Online Pharmacies Canada
Suite #2001, 7495 132nd Street,
Surrey, BC., Canada V3W 1J8

Cover Sheet

Total Number of Pages (including this sheet)


Your Name: (as written on prescription)

1. Complete & sign the attached form

2. Fax toll-free 1-888-536-8192 (or mail) along with a copy of your original Prescription and a copy of a Picture ID or 2 of the following: birth certificate, passport, voter's card, marriage certificate, or military ID.

** Please note: if you order your prescriptions by mail, there is a $9.95 USD shipping fee ($15.95 USD for cold-pack items) per patient for an unlimited number of prescriptions. All prescriptions will be authorized for a 1-year period if indicated by the physician and will be honoured from the date on the prescription form. All prescription drug prices include prescribing fee and pharmacy dispensing fee.

Please Attach Prescription to the Box Below Before Faxing:

Attach Prescription Here


 

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