CANADIANPHARMACYWEB - AFFORDABLE PRICES FOR EDUCATED CONSUMERS



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Place A Refill
 
I am an existing customer of CanadianPharmacyWeb.com, and this refill is for a prescription previously ordered through CanadianPharmacyWeb.com If you prefer, please feel free to call in your refill request toll free 1-866-875-6285.

*Fields required to be filled for your request.
 
 
  First name Shipping Address
 
     
  Last name City
 
     
  Phone Number State
 
     
  Email Address Zip Code
 
 
 
Informed Consent for Patient Counseling

All patients receiving prescriptions from a British Columbia pharmacy have the right to receive counseling from a licensed pharmacist.

 
  Would you like a pharmacist to call and discuss your order with you?
  Yes No
 
  Are you sending a new prescription to be processed with this order?
  Yes No
 
  Did your mailing address or telephone number changed since the last order?
  Yes No (if yes, please specify above)
 
Refills Requested
 
  *Medication Name   Drug Strength
e.g. 10 mg/ml
  *Quantity
Number of tablets capsules, mls, etc.
  Generic
Allow generic substitution
 
       
       
       
       
       
       
       
       
       
       
 
 
 


 
 
 
 

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