New Pharmacy Patient Enrollment

Non-prescription orders do not require pharmacy enrollment. Non-prescription orders are delivered free (no minimum) with your prescription or free without a prescription for any orders over $50!

For prescriptions, you must first be enrolled with Pharmex Direct. Enrollment is free, but required so that we have your contact details on-file. Please fill out the form below, and our pharmacy staff will be in touch.

(You may also click here to download and print an enrollment form to fax to us.)

    Personal Information

    Family Members


    How did you hear about Pharmex Direct?

    Request for Prescription Transfer (Optional)

    By completing the section headed "Request for Prescription Transfer", I acknowledge that I have requested Pharmex Direct to have my medication records transferred from the above pharmacy. Please note: Narcotic prescriptions cannot be transferred - a new prescription will be required.

    Upon submission of the above information, your patient file will be setup with Pharmex Direct Inc. Your records will be revised with every prescription, and an updated Pharmex Care Card will be provided to you.

    Once enrolled, ask your doctor to send your prescriptions directly to us. You may also mail written prescriptions to us. Existing prescriptions can be transferred from another pharmacy.