Select the Form you need by clicking on the form name. A new window will open with a button for printing.

1. Form A - New Customer Order
   If you are a new customer ordering prescription drugs from us for the first time.
   
   
2. Form B - Existing Customer New Order
   If you are an existing customer ordering drugs under a newly issued prescription.
   This form is also used for replacement prescriptions. A replacement prescription is a newly issued prescription for a drug previously ordered (no change in strength or dosage).
   
   
3. Form C - Existing Customer Refill Order
   If you would like to reorder/refill a drug that you ordered from us previously under an existing prescription.
   
   
4. Fax Cover Page
   Use this fax cover page when faxing in your prescription.
   
   

All prescriptions for USCanadianPharmacy.com are dispensed by:
Extended Care Pharmacy
Calgary, Alberta Canada - Licensed by:
The Alberta College of Pharmacists - Lic.# 1636