First Name (required)

Last Name (required)

Your Email (required)

Year of Birth* (4 characters) (required)

Phone Number*

Prescription Numbers*

Prescription#1
Prescription#2
Prescription#3
Note: Your prescription # can be found on your prescription label.
Also, if you have more than three (3) prescriptions, please fill out the form a second time.

Select a Location
317 E. Columbia Street New Westminster, BC V3L 3W8

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DeliveryPick-up

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