Thank you for trusting High Park Pharmacy to fill your next prescription. Please complete the following form to transfer your prescriptions to our pharmacy. We will contact you when your prescription is ready.
Fill in this form to tranfer your prescriptions to the High Park Pharmacy.
Pharmacy Name:
Pharmacy Phone Number:
Drug Names and Prescription Numbers:
(The prescription number is on the top left corner of the label, provide as much information)
Your Name:
Your Daytime Phone:
Your Email:
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