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Electronic Prescription

1. Complete the Form

Please complete the form to initiate the electronic prescribing process.

2. Consultation Required

No prescriptions can be dispensed without a recent in-person or virtual medical evaluation consultation.

3. Administrative Charge

An administrative charge for prescriptions may apply.

Need a Consultation First?

If you have not been evaluated recently, please book a virtual or in-person consultation before requesting a prescription.

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Electronic Prescribing

Prescription Request

Name *
First
Last
Please fill in your birthday.
Pharmacy *
Pharmacy Name
Pharmacy Address
Pharmacy Phone Number
Terms & conditions *
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