CANADIAN PRESCRIPTION FORMS AND POLICIES
Customer Agreement Form:
This form must be completed once every 12 months and will be kept in your file. Once on file it will not be needed for reorders. If order is for more than one person you must fill out separate forms. Must be completed for first order. (Reorders can be completed over the telephone once Customer Agreement Form and Health Questionnaire Form have been signed and received by processing center).
Health Questionnaire Form:
This form must be completed once for your file, unless your medical condition has changed. Once on file it will not be needed for reorders. If order is for more than one person you must fill out separate forms. Must be completed for first order. (Reorders can be completed over the telephone once Customer Agreement Form and Health Questionnaire Form have been signed and received by processing center).
Medication Order Form:
Must include accurate customer mailing information. You may have a physical address as well as a post office box number. The address we require is your mailing address (if you pick up your mail at a post office, that is the address we need).
A representative may contact you within a couple of days of receiving your order. It is therefore important for you to include a telephone number on your order form where you can be reached at.
Please pay extra attention when providing credit card numbers, whether on the order or over the phone. Any orders with incorrect or invalid credit card numbers (as well as insufficient funds) will not be processed until suitable payment arrangements can be made.
We accept VISA, MASTERCARD and money orders. All money orders must be made payable to: The Canadian Pharmacy.
Please note that if the order is for more than one person, separate order forms need to be filled out for each person.
Click here to print your forms
Prescriptions:
We require a copy of your valid prescription that has been obtained from your doctor. We have included an updated price list with this package. We would prefer that you send us a copy of your Doctor’s prescription so you can maintain the original for your records.
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