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

Transfer over the phone by calling us at
or 905-387-7125.

Have your doctor fax us your refill prescriptions at

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


Date last filled

Prescribing doctor name

Have any questions?

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