"*" indicates required fields
Patient’s Full Name *
Date of Birth *
Contact Number *
Email Address *
Refill Order(s) * (Please use "," for 2 or more refill orders - eg: 15551, 16338, 18433)
Note: Prescriptions can be picked up 24 hours (1 business day) after the refill request has been submitted. Please call the Pharmacy at 416-283-1986 prior to collecting the prescription to confirm the order.
Special Instructions