Prescription Refill

Request a Prescription Refill

Easily request a refill for your existing prescription at pharmacy location:

373 Bridge Street W
Waterloo ON N2K 3K3
Canada

Important Disclaimer

Submitting this form does not guarantee an immediate refill.
Your request will be reviewed, and a pharmacy team member will contact you to confirm the refill details within one (1) business day.
Do not use this form for urgent requests or new prescriptions.

Prescription Refill Form

Name

This field is for validation purposes and should be left unchanged.

Patient Name(Required)

First Last

Contact Phone Number(Required)

Your Email Address(Required)

Prescription Numbers

Please separate prescription numbers with commas

Yes call me

Your Comments/Questions