Pharmacy Forms

Under Policy 51 of Health Canada and the regulations set forth by the College of Pharmacists of Manitoba, you are obligated to submit this form before requesting your first official order. The form also contains a Payment Authorization section that must be completed to proceed with your order.

Feel free to request a price quote at any time without commitment to make a purchase. If the pharmacy and/or patient agrees to the quoted price and you wish to proceed with an order, kindly return this form signed for a one-time purchase. For future orders, please use our standard order form for regular transactions.

Upon completion of your registration and submission of required forms, you are now able to place orders with us. Below, you will find our available order forms.

Introducing our most compounded product: Diclofenac in various strengths! Feel free to place your order by clicking the link below.

“Want your medication delivered? Please review our terms and conditions.