Once you have submitted the questionnaire please call the pharmacy at 613-526-3666 to set up an appointment.  Appointments will only be made once the questionnaire has been completed.

 

Personal Information

1. First Name(required)
2. Last Initial(required)
3. Date of Birth (mm/dd/yyyy)(required)
4. Email(valid email required)
5. Confirmation

 

cforms contact form by delicious:days