Jan Drugs - reliable and affordable medications from
Canada
Jan Drugs Inc. is licensed by the Manitoba
Pharmaceutical Association, License # 32476
Jan Drugs Inc. is located at 210 - 530
Phone: (toll free)
1-866-395-3784 Fax: (toll free)
1-866-412-3784
This form may be shared, we encourage you to make copies for friends and
family.
Thank you for your interest in Jan Drugs. Ordering prescription drugs from Jan Drugs is
a simple process. To help us serve you better
and protect your health please fill out all the forms carefully and
completely. If you prefer you may
complete your order on-line at www.Jandrugs.com
3 Step Process
1/ Contact us for
the exact price of your medication.
Please call us toll free at 1-866-39J-DRUG (1-866-395-3784) or visit
www.jandrugs.com
2/ Complete
your order form and medical questionnaire.
3/ Send your
completed order form along with your prescription to us by mail, fax or web
form. Fax toll free 1-866-412-3784 or
mail to Jan Drugs, 210 - 530
Confidentiality and Use of
All
information you provide to Jan Drugs will remain confidential and be used to
create your medical record. A Canadian physician will review your medical
questionnaire, and may contact you or your physician if additional information
is required. Please be thorough and use extra paper if necessary.
Quantities and Refills
International
customs permits a maximum 3 month (100 day) supply of your medication to be
mailed to you from
To
ensure that your medications are still needed and appropriate we will only
honour refills for one year. After a year we
require you to send a new prescription. Please inform us of any changes to your
health or medications at any time.
Charges
1/ Drug cost, as quoted by our staff, or posted on our web
site. Drug costs are subject to change,
and we will always strive to save you the most money possible.
2/ Shipping and handling fee of $9.95 US
per order. (not
per drug)
3/ We will not
charge your credit card until we have completed your order.
Shipping and Processing
Processing
your order takes seven to ten business days once we have received all your
information, and shipping takes seven to ten days. If you have not received
your order within two weeks please contact us. If you have not received your
medications three weeks after shipping we will either refund your payment or
reship the order. If your prescriptions are coming from both
Return Policy
Due
to the nature of our product we are not able to accept returns. All sales are final once shipped.
Drug Availability
1/ We do not ship narcotics or habit forming medications.
2/ Not
all medications available in other countries are available from Jan Drugs.
3/ If
for any reason the medication you have requested is not immediately available
we will contact you as soon as possible.
Generic Substitutions
We
make generic substitutions wherever possible to maximize your savings, unless
you or your prescription specifies otherwise.
Any generic drug dispensed has been approved for substitution by
Canadian officials.
Questions?
Call anytime 1-866-395-3784 (1-866-395-DRUG)
General
questions info@jandrugs.com
Medical questions
You do not need to fax or mail this page. Please keep for your records.
This form may be shared, we encourage you to make
copies for friends and family.
Patient
First Name___________________________________
Last Name______________________________________
Email
Address___________________________________
Address______________________________________
City________________________________ State
_______________________ Zip_____________________
Phone (Day) ________________________________
Phone (Other) ______________________
Gender (m/f) ______ Weight (lbs.) ________ Date
of Birth (Month/Day/Year) ______________________
Would you like web access to your Patient
Profile YES____
If yes, please choose an account password, (case
sensitive) ____________________
Secondary Contact ______________________
Relationship To You _____________Phone Number
_________________
Patient Acknowledgement
I
acknowledge and agree as follows:
1. I appoint Jan Drugs (a.k.a. Jandrugs) to act as my
agent as required to either fill my prescription directly or to securely
communicate my provided information to a licensed pharmacy in the UK, New
Zealand or Fiji as required for the purposes of obtaining my prescription or
product directly from the pharmacy. My prescription is filled according to the
laws of the jurisdiction in which the dispensing pharmacy is located. All
Canadian prescriptions are filled by Jan Pharmacy,
2. Jan Drugs is located in the country of Canada and that the physicians and
pharmacists working for Jan Drugs are located and licensed to practice medicine
and pharmacy, respectively, in Canada only and any treatment, if any, I am
receiving from such physicians and pharmacists shall be deemed to be received
by me in Canada. Some products are supplied by Jan Drugs’ partner pharmacies in
3. I am eighteen years of age or older and am fully competent to make my own
health care decisions. I am aware of the potential side effects and/or problems
associated with prescription medications and understand that it would be a
violation of the law to falsify any information on my medical questionnaire. I
agree that if I fail in any way to fully furnish my complete and accurate
medical history if I become aware of any changes in my physical or medical
condition and I fail to notify Jan Drugs of such failure, that I am solely
responsible for any adverse effects that I may suffer from taking or continuing
to take such prescribed medications.
4. No person other than me will use the ordered product.
5. Medications purchased from Jan Drugs are approved by the Health Products and
Food Branch (HPFB) of Canada or the relevant national ministry of Health for
products dispensed from Jan Drugs International partner pharmacies. Medications
purchased from Jan Drugs have not been inspected by the FDA.
6. Due to the nature of the product the product may not be returned for a
refund or for an exchange.
I HAVE READ AND UNDERSTOOD THE ABOVE REFERENCED PATIENT ACKNOWLEDGEMENT
AND AGREE TO EACH OF THE FOREGOING TERMS
Patient’s Name (Print Clearly) Patient’s Signature Date (Month/Day/Year)
____________________________ ____________________________
____________________________
This form may be shared, we encourage you to make copies for friends and
family.
Full
Name________________________________Signature_______________________________
Date _____________
Have you had a physical examination
in the last 12 months? Yes ____ No
____
Doctor’s Name Doctor's Address, City, State, ZIP
__________________ __________________________________________
Phone_______________
Fax_______________ License Number_______________
Please
indicate any known food or drug allergies.__________________________________________________________
Medications Currently Being Taken including those not
being purchased from Jan Drugs
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Medication Taken |
Dosage |
Frequency |
For |
Illness/Diagnosis |
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1. |
Cancer |
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6. |
High blood pressure |
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11. |
Liver disease |
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2. |
Heart disease |
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7. |
Lung disorders |
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12. |
Kidney or renal disease |
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3. |
Diabetes |
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8. |
Arthritis |
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13. |
Stomach problems |
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4. |
Seizures |
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9. |
Osteoporosis |
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14. |
Emotional disorders or depression |
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5. |
High Cholesterol |
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10. |
Glaucoma |
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15. |
Smoker |
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16. |
Other Illness not yet noted |
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Please give further detail for any boxes checked above: |
Medication
Being Ordered
Generics
At Jan Drugs we strive to maximize your savings by filling
your prescription with generic medications wherever possible. If a lower priced
generic is deemed substitutable by the Manitoba Pharmaceutical Association we
will substitute it for your requested product unless your prescription is
written “No Substitutions.” Please call us if you would like more information
about the benefits of generics, or ask your doctor..
Yes, I
would like to use generic medications wherever possible to maximize my savings.
No,
thank you. I understand this may cause a delay in processing my order if my
doctor needs to be contacted for a non substitutable prescription.
Please understand that pricing is subject to change
due to drug costs, and exchange rates. We may also be able to save you
money by substituting lower costs medications. We will notify you of any
changes in your cost before we ship your order or bill your credit card.
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Strength |
Quantity |
Price |
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Add Shipping |
$9.95 |
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Total Cost (in US Funds) |
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When
planning your order understand that the more you buy the
more you save. The cost per pill or capsule goes down with larger quantities,
and the shipping cost is always $9.95.
International
orders for greater than a 3 month (100 day) supply will be automatically
adjusted to 3 months (100 days).
All patients
receiving prescriptions from a Manitoba licensed pharmacy are entitled to
counselling for their medications.
Have you
been taking the medications you are ordering for the past 30 days? Yes No
We recommend ordering a smaller supply for new
medications because of the higher chance of side effects. Products ordered from
Jan Drugs are not returnable.
All
medications will be dispensed in child safe packaging unless otherwise
specified.
Do you decline child – safe (hard to open) packaging for your order?
Decline
Payment Method Visa
Master Card
Personal Check, Void Check or Money Order
(included with form)
|
Cardholder Name |
Credit Card Number |
Signature |
Expiry (Month / Year) |
|
__________________________ |
________________________ |
____________________________ |
_________________ |