This form provides Pharmex Direct with the information necessary to fill your prescriptions. For new prescriptions, have your doctor fax or phone
the prescription to us. If you already have a prescription, you may also mail it to us.
If you’d prefer, here is a printable version of our enrollment form which you can mail or fax to us. If you are an existing Pharmex
customer and require a repeat prescription, please use the repeat prescription form or contact us.
Note: Provincial law prohibits you from faxing your prescription to us directly.