Refills

Please complete the form to request prescription refills.

Your prescriptions will be ready to be picked up within 1 business day at Sage Pharmacy.

If your request is urgent or if you have questions, please call us at 416-481-8891

Name

First Name

Last Name

Cell Phone

(###)

###

####

Do you require delivery?

A signature is required upon delivery of your prescription.

PRESCRIPTIONS

Please include the prescription name and/or prescription number.

Prescription 1

Prescription 2

Prescription 3

Prescription 4

Prescription 5

Prescription 6

Prescription 7

Prescription 8

Additional Prescriptions

Please enter the names / numbers of any additional Prescriptions you need refilled, 1 prescription per line.

Comments / Special Requests / Request for Delivery

If you require delivery, please let us know in the comments below and include your delivery address. Signature is required upon delivery.