Transfer

Transfer your medications to Concession Medical Pharmacy online by completing the form below.

Transfer over the phone by calling us at
1-844-832-9102
or 905-387-7125.

Have your doctor fax us your refill prescriptions at
1-844-832-9329.

Nurse answering phone
Nurse answering phone

Transfer Form

Please call your current pharmacy as soon as possible to gain consent for your medication prescriptions transfer. Fields marked with * are required

Patient Details

Patient full name *

Email address

Pharmacy Information

Current pharmacy name *

Current pharmacy phone number *

Current pharmacy address

Medication Information

Medication name and strength *

Prescription number

Last quantity filled

Directions

Date last filled

Prescribing doctor name

Have any questions?

We can help!

Contact Us