(613) 518-0022
info@jpharmacy.ca
Mon. - Fri. 8:00 – 20:00 Sat. 8:00 - 14:00 Sun. Closed

FILL NEW PRESCRIPTIONS

REFILL PRESCRIPTIONS

TRANSFER PRESCRIPTIONS

COVID / FLU SHOT APPOINTMENT

MINOR AILMENTS APPOINTMENT

Fill New Prescriptions

PLEASE DON'T FORGET TO BRING THE ORIGINAL COPY OF YOUR PRESCRIPTION WHEN YOU COME TO PICK IT UP

First Name *

Last Name *

Date of Birth *

E-mail address

Phone Number *

Please attach your prescription (If possible) *

Drag and drop files here or Browse

I AGREE TO TRANSFER MY INFORMATION IN THIS EFORM ELECTRONICALLY AND I FULLY UNDERSTAND THE RISK.

reCAPTCHA Invisible *

Name