Transfer Prescriptions

Transfer Prescriptions using Request Form

Complete the form to transfer your prescriptions.

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Patient Information

• First NameRequired Last NameRequired
• Birth DateRequired DD/MM/YYYY

  Birthdate Day (DD) Birthdate Month (MM) Birthdate Year (YYYY)
  EmailRequired
• Phone Number Required

  Phone Area Code Phone First Three Digits Phone Last Four Digits
  Secondary Phone Number

  Secondary Phone Area Code Secondary Phone First Three Digits Secondary Phone Last Four Digits
• AddressRequired City or TownRequired
• ProvinceRequired Choose from List Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Northwest Territories Nunavut Yukon Postal Code Required A1A 1A1

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Transferring Pharmacy Location

• Existing PharmacyRequired Choose from List DRUGstore Pharmacy Guardian I.D.A. Jean Coutu Loblaws Pharmacy London Drugs Lovell Drugs Medicine Shoppe Metro Pharmacy Overwaitea Pharmacy Pharmaprix Pharmasave Remedy Rx Rexall Rexall Pharma Plus Safeway Shoppers Drug Mart Sobeys Pharmacy Target Total Health Pharmacy Uniprix Walmart Other
• Other
  Pharmacy Phone Number Required

  Sending Pharmacy Area Code Sending Pharmacy First Three Digits Sending Pharmacy Last Four Digits

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Pharmacy Being Transferred To

• Choose a Rexall Pharmacy Location

  You may search by phone number or location to find your Rexall pharmacy.

• Pharmacy Phone Number

  Receiving Pharmacy Area Code Receiving Pharmacy First Three Digits Receiving Pharmacy Last Four Digits
  or Search by Location

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• • Select Your Preferred Store Search by phone number or location
  • Selected Store

    | Change Preferred Store

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Prescription(s) to be Transferred

Please provide us with drug name or prescription number for each of the prescriptions you would
like to transfer to Rexall.

Yes, please transfer all of my prescriptions to Rexall
No, I only want certain prescriptions to be transferred.

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Important Note

Rexall is committed to protecting the privacy of our customers' information. Any and all information provided on this form will be kept strictly confidential in accordance with our privacy-policy.

By submitting this form you are giving consent for a Rexall representative to contact the transferring pharmacy indicated to complete your prescription transfer request. Prescription transfers occur digitally or via facsimile, and Rexall may use third party service providers to facilitate a prompt transfer.

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