Pharmacy Transfer Form

Welcome to Victoria Wellness + Pharmacy

Pharmacy & Prescription Transfer Form
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Name of Previous Pharmacy
Previous Pharmacy Phone Number
Please enter a valid phone number.
Type a question

Transfer all of my prescriptionsJust transfer the RX(s) that I enter below
Type prescription name or number that you would like us to transfer below
Notes for the Pharmacy Staff
I agree for Victoria Wellness & Pharmacy (130 Victoria St. S, Kitchener, ON N2G 2B5) to transfer the prescription(s) above per the Ontario’s Drug and Pharmacies Regulation Act (DPRA), Food and Drug Regulations, Narcotic Control Regulations and Benzodiazepines and Other Targeted Substances regulations and guidelines Regulation act. Click to learn more
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Victoria Wellness & Pharmacy

Address: 130 Victoria St South (Unit A), Kitchener Ontario N2G 2B5

Phone: 519-744-8989

Fax: 519-744-4499

Email: Rx@victoriawell.ca
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Welcome to Victoria Wellness + Pharmacy