Refill Prescription

Refilling your prescription has become more convenient than ever. The form below takes a few minutes to fill and a call will be made once the order is ready!

442 Queen St. Blyth, ON N0M1H0

Phone: (226) 256-8383

Name

First Name

Last Name

Phone

(###)

###

####

Date of Birth

YYYY

Rx Number (s) - You can add multiple Rx Numbers, separate with comma

Name of Medication (Optional)

Pickup or Delivery

If requesting Delivery, please type address

If there is anything else you would like us to know, type it here

Refill Prescription

Blyth Pharmacy