Online Rx Refill Request - Trutina Pharmacy Human Services

Online Rx Refill Request Form

Please provide the following required information to process your prescription refill. If you have any questions or concerns, please contact the pharmacy directly at (905) 304 -9300 or toll-free at 1(866) 418 – 9303.

Please contact the pharmacy directly if there have been any changes to your billing information.

By using this online service, you are agreeing to Trutina Pharmacy’s Online Rx Refill Terms and Conditions.

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.