Download Canadian Pharmacy Discount Drug Forms

Discount Prescription Drug Order Form

If you would prefer not to order online at Jandrugs.com, you can simply fill out our Order Form and fax us your information.

Please note: It is not necessary to download and complete this form if you have already placed an order online.

Order Form (.pdf format)

If you will be transferring your prescription from another pharmacy please fill out our Rx Transfer Form and fax it to us.

Very similar to our "Patient Questionnaire" but for your pet's medications. Just fill in your pet's information and fax it to us.

You will need Adobe Reader to view and print these forms. If you do not have Adobe Reader you may download a copy here.

Jan Pharmacy
250-530 Kenaston Blvd.
Winnipeg MB R3N 1Z4
Canada

1-866-395-DRUG (3784) (toll free)
1-866-412-DRUG (3784) (toll free fax)

1-647-426-7039 (local or outside North America phone)
1-204-928-2039 (local or outside North America fax)

All Canadian prescriptions are filled by Jan Pharmacy, licensed by the Manitoba Pharmaceutical Association, License # 32476