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How to Order by Fax or Mail

1. Fill out a patient questionnaire

Click here to download a patient questionnaire form.

If you are transfering a prescription to us from another pharmacy, please also fill out a prescription transfer form.

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

2. Send your form(s), prescription(s), and payment

Please fax, email, or mail your completed form(s), prescription(s), and payment. If you wish to fax or email us your prescription(s), please also mail us your original prescription(s).
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03/17/10

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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)

© Copyright 2010, Jan Pharmacy

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