Formulaire de demande de renouvellement en ligne

Veuillez fournir les renseignements suivants afin que nous puissions traiter le renouvellement de votre ordonnance. Si vous avez des questions ou des préoccupations, veuillez communiquer directement avec la pharmacie au (905) 304 -9300 ou au numéro sans frais 1(866) 418 – 9303.

Veuillez communiquer directement avec la pharmacie si des changements ont été apportés à vos renseignements de facturation.

En utilisant ce service en ligne, vous acceptez les conditions générales d’utilisation de la pharmacie Trutina.

Your Information

First Name(Required)

Last Name(Required)

Date of Birth(Required)

Phone Number(Required)

Shipping Address(Required)

Email Address(Required)

Communication by email(Required)

I consent to communication about my medication and health by email

I do not consent to communication about my medication and health by email

Prescription to be filled

Please provide the Rx numbers of the prescriptions you would like for us to refill. The Rx number is the 6-digit number at the top left of the official prescription receipt. Alternatively, it is on the top left corner of the prescription label.

Please note that you are able to fill up to 4 prescriptions on a single request form.

Rx Number(Required)

Please add any special details relevant for your prescription refill

In the event additional refills are not available(Required)

I consent for Trutina Pharmacy to contact the prescribing practitioner in order to request additional refills on my behalf.

I do not consent for Trutina Pharmacy to contact my healthcare practitioner on my behalf.