Request a Health Profile transfer^*

Please fill out the form.
Your new pharmacy will contact you by telephone.
Your file has been transferred!

Transfer My Health Profile to this pharmacy

Suggested store

Pharmacist owners affiliated with

Open today until 4 pm

Personal information

First name

Last name

Birth date

Gender

Contact

Telephone number

ext. (optional)

I am aware of the pharmaceutical services offered by the pharmacy mentioned above. I agree to transfer my prescriptions. I was not coerced into making this decision.
I understand that this form, authorizing my consent, will be sent to my current pharmacist.
I remain free to change pharmacy at any time if I am no longer satisfied. In the event of change, this authorization will no longer be valid.