Request for refill prescription:

First and last name:* 
E-mail address: 
Street address:* 

*) Required fields

Please fill in the following field with details about your refill prescription. The prescription will be ready for pick-up on the next workday at our clinic, between normal business hours. Please bring along your Healt Care Card when picking up the prescription.


Please fill in the field with details about your request:

Thank you!

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