Request a Prescription Renewal

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Please call (613) 233-303o to find out about advertising opportunities.

Please use the form below to request a prescription renewal

Your Full Name*
Your Date of Birth*
Date Format: MM slash DD slash YYYY
Your Pharmacy Name*
Your Pharmacy Telephone Number*
Your Pharmacy Address
Street Address Address Line 2 City Province Postal Code
What Medication(s) Would You Like Renewed*
Email
This field is for validation purposes and should be left unchanged.