TRANSFER YOUR FILE LINK

FILE TRANSFER REQUEST

First Name *

Last Name *

Phone Number *

Date of Birth *

Email Address *

Street Address *

Unit Number (If Applicable)

Province *

Postal Code *

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Name of the pharmacy you would like to transfer your file from *

Pharmacy Phone Number *

Street Address (Not Required)

Additional Instructions (Optional)

Consent *

I consent to transfer my information electronically & I understand the risk of transferring data over the internet.

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