print cart refillAshish2022-11-24T12:34:11+00:00 Quality Prescription Drugs mail/fax orderform Fax to: 1-877-868-4804 Or mail to: Canada Online Healthlink Inc. on behalf of QualityPrescriptionDrugs.com Suite #245 7360 137th Street Surrey, B.C. V3W 1A3 Cover sheet Total Number of Pages (including this sheet): Your Name (as written on prescription): 1. Complete and sign the attached form 2. Fax toll-free 1-877-868-4804 along with a copy of your original prescription and a copy of a Picture ID or 2 of the following: birth certificate, passport, voter’s card, marriage certificate, or military ID. ** Please note: if you order your prescriptions by mail, there is a $9.00 USD shipping fee ($15.95 USD for cold-pack items) per patient for an unlimited number of prescriptions. All prescriptions will be authorized for a 1-year period if indicated by the physician and will be honoured from the date on the prescription form. All prescription drug prices include pharmacy dispensing fee. Please Attach Prescription to the Box Below Before Faxing: Cart details Medication 1 Qty Medication 2 Qty Medication 3 Qty Medication 4 Qty Medication 5 Qty Medication 6 Qty Medication 7 Qty Medication 8 Qty Medication 9 Qty Billing address First Name: Last Name: Address: City / Town: State / Province: Zip / Postal Code: Email Shipping address First Name: Last Name: Address: City / Town: State / Province: Zip / Postal Code: Email: Print Form