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Prescription?

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Choose what to do.(Required)

I need a prescription refill

I have a new prescription to fill

Full Name(Required)

First

Email(Required)

Care Card/Health Card #(Required)

Date(Required)

Phone(Required)

Current Address(Required)

List all of the medication names or prescription numbers(Required)

Please be sure that all uploads are clear and in focus

Upload a copy of each new prescription(Required)

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File(Required)

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Accepted file types: jpg, png, Max. file size: 10 MB.

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Is your prescription currently with Beyond Pharmacy?(Required)

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No

If you feel everything's perfect click submit.

What pharmacy is your prescription currently at?

Pharmacy Name(Required)

Pharmacy Address(Required)

Pharmacy Phone #(Required)

Agree(Required)

I authorize Beyond Pharmacy to transfer my prescription from the above pharmacy