Send Prescription

If you were given a paper prescription by your doctor, you may send it to us electronically so we can prepare it in advance and reduce your wait time.

The prescription MUST be provided to the pharmacist at the time of pickup.

By completing this form, you consent to allow the collection and use of your personal information for the purpose of filling your prescription at Garibaldi Pharmacy and understand that all personal information will reside at Garibaldi Pharmacy.

A pharmacy staff member will contact you to when your prescription is ready.

Legal First Name

Legal Last Name

Sex

Date of Birth

Personal Health Number

Cell Phone Number

Submit photos of prescription and any insurance plan cards:

Please follow these instructions to ensure there are no delays in processing your prescription:

Please place your prescription on a flat surface with adequate lighting
Make sure to take a photo of the entire page of the prescription
Review each photo to ensure text is legible and in focus
When taking photos of insurance plan cards, please take photos of the entire card (both front and back).

Note: If you have previously submitted your insurance plan cards, the pharmacy will already have this in our system. You will only need to take a photo of your insurance plan cards if the information has changed.

Prescription 1

Prescription 2

Plan Card 1

Insurance Card 1 (Front)

Insurance Card 1 (Back)

Plan Card 2

Insurance Card 2 (Front)

Insurance Card 2 (Back)