Print Your Prescription Forms
This page contains all the necessary forms for you to print out and complete. Forms are available in PDF Format.
DOWNLOAD INDIVIDUAL FORMS
1. Customer Agreement
The Customer Agreement Form needs to be read, understood, signed, and sent to Rx Care Canada before the FIRST order can be filled, and shipped to the customer. This will be accompanied with FORMS B & C, and prescription(s) from doctor
2. Patient Allergy/Interaction Form/Order Form
The Patient Allergy/Interaction Form/Order Form will be sent with your FIRST order with a signed PATIENT AGREEMENT form & PRESCRIPTION from doctor. Refill Orders only require this form.
Download FORM - PDF FORMAT
The forms contained on this web page require you to download Adobe Acrobat (FREE) to be able to view the Order Forms correctly. Please download a copy if you don't have one already installed.
Have you or your doctor FAX your prescriptions TOLL FREE to 1-866-335-8064 or mail to:
The Canadian Pharmacy.
Order Processing Center
Suite 84 – 1313 Border Street,
Winnipeg, Manitoba
R3H 0X4 Canada
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