Pharmacy Sign-up Form

 As per Health Canada Policy 51 and the College of Pharmacists of Manitoba, you must complete this form BEFORE you place your first price quote request or order.  Once you have signed up officially, we will be happy to serve your needs, even if you just need a price quote 

Once you are signed up with us, you may send in a price quote request at any time with no obligation to order.  Once the pharmacy and/or patient has agreed to the price and you wish to order, you may send back this form with your signature as a one-time order. After that, the regular order form should be used for general ordering 

 Once signed up with us, you may use this form to order products at any time. Most compounds are prepared SAME DAY to NEXT DAY service. A member of our team will contact you with any anticipated delays in service.   If you are interested in obtaining our diclofenac in PLO order form, please contact us by phone or email to have this sent to you.  We apologize as we are unable to keep this on the website due to college requirements. 

 This form must be used to request a complete ingredient list for a compound that has been previously ordered. 

If you are a new owner, or taking over ownership of a pharmacy, please complete a new sign-up form with us and maintain this agreement in your files.

You can also refer to it online at any time here.

 For more information on Health Canada’s Policy on Manufacturing and Compounding Drug Products in Canada (POL-0051), please click on this link.