Ordering Canada Drugs with CanadaRX is easy!

Simply print out and complete the patient health profile and order form. Then attach your original prescription and fax a copy of all of the documents to our toll free fax number: 1-866-366-5381

Please note that it may take as long as 21 business days for you to receive your prescription drug order.

Printable Prescription Order Forms

The pages will open in a new window in printer friendly pages.

Fax Forms Directions

Patient Information:
Enter the Patient's Personal & Billing Information. List all of the prescribed medications in the table.

Note: Invoice will reflect Canadian dollars; credit card statement will reflect US dollars.

Physician Information:
Please list the Physician Information including the DEA # and License information.

Prescription Information:
Please list the Prescription Information including the Strength, Quantity, etc...

Sending Your Information:
Once you have completed the Patient Health Profile and the Order Form please attach the original prescription and fax the documents to our toll free fax number: 1-866-366-5381

Refilling your prescription with CanadaRx

If you would like to order a refill on a prescription that we have previously filled for you, please complete the form provided and submit to CanadaRx.com.

Your CanadaRx invoice also contains our toll free refill number. If you prefer, please call in your refill request and we will process your order in an efficient and timely manner. The toll free refill number is 1-866-262-2174.

Refill Form

First Name:
Last Name:
Email:
Phone:
Physician's Name:
Invoice #:
City:
State or Province:
Zip Code:
Country:
Please enter any  instructions here:

Please type your Full Name below to electronically authorize this refill order.

Signature:

Please only click the submit button once.