Contact Us | Site map

Hours of Operation:
Mon. to Fri. - 7 a.m. to 9 p.m. CST, Sat. from 8 a.m. to 4:30 p.m. CST

Mailing address:
10 Terracon Place, Winnipeg, Manitoba, Canada, R2J 4G7
Phone: toll free at 1-888-700-1119, or 204-867-5644
Fax: toll-free 1-866-773-2696, or 204-867-5646

close window

ordering Canadian drug order forms

order formsIf you are already a member of the RxNorth family, all you need to do is complete the Canadian Medication Order Form requesting your medication and send it, along with your prescription(s), to us by fax, mail or email.

For those of you who are new to, with your initial order we require the following information. This may be provided by completing the four forms listed below or by talking directly with one of our Customer Service Representatives:

Medication Order Form

This form gives us your billing and shipping information and requested medication.

  1. Download the ORDER form

Authorization Form

This form allows us to process your order.

  1. Download the AUTHORIZATION form

order formsPatient Allergy Form

This form helps the licensed pharmacists who review your prescription ensure you are not receiving medication that conflicts with any existing allergies or drugs you are already taking.

  1. Download the PATIENT ALLERGY form

Patient Health Profile Form

This form is similar to one you might fill out when visiting your doctor. This additional information helps our medical team and licensed pharmacists when they are reviewing and verifying your prescriptions. It includes contact information for your prescribing physician, so our medical staff can contact them with questions.

  1. Download the PATIENT HEALTH PROFILE form

Minor Consent Form

If you require copies of the forms, please call us toll-free 1-888-700-1119 and we can send them to you.

Adobe Reader To view the forms you need the Adobe Reader. Download it for free here.

clopidogrel 75mg
1 x 100 Film-coated Tablet $162.67

Subtotal: $162.67

shopping cart Edit Cart | go to checkoutGo to Checkout

close window