Pharmacy Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 3 All medications we dispense must be prescribed by the medical doctor, dentist, pharmacist (applicable only for minor ailments & contraceptives), or a nurse practitioner. Bring your prescription to our pharmacy or order online. To order online please fill out the order form below, we will call you to confirm your order. Name *FirstLastAddress *Address Line 1CityState / Province / RegionPhone *Email *Date of birth *Upload Your Prescription * Click or drag a file to this area to upload. Choose Your Pharmacy *Select Pharmacy NameCascade PharmacyVedder PharmacyOtherOther Pharmacy NameNextMSP / Personal Health Number *How many items do you need to order? *– Please select –123Item 1MedicationQuantityItem 2MedicationQuantityItem 3MedicationQuantityNextPrescription delivery *I will pick up my medicineI will prefer doorstep deliveryPickup Location *ChilliwackHopeMessageSubmit
