STEP 1: Print and sign the Order & Waiver forms below.

STEP 2: Fax completed forms along with a copy of your ORIGINAL PRESCRIPTION and photo identification to Toll Free Fax 1-866-402-4033 or 1-866-352-4988. If sending by mail, please send to:
Buy Low Drugs
#9 31205 Old Yale Road
Abbotsford BC Canada V2T 5E5
Toll Free Phone 1-866-596-4364 or 1-866-305-6337
email: info@buylowdrugs.com

STEP 3: Your prescription will be reviewed by a licensed Canadian physician and verified via phone with your doctor. NOTE: Canadian pharmacies cannot dispense drugs to patients without a valid prescription. Please allow approximately 10-14 business days from the time we receive your order to final delivery, to account for order processing, verification, and delivery time.

A) PATIENT INFORMATION

First Name:
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Last Name:

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Address:
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City:
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State:
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Country:
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Zip:
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Telephone:
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Alternate Telephone:
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Fax:
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Email:
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Birth date:
(dd/mm/yy)
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Gender:
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B) PAYMENT INFORMATION (VISA or MasterCard #)

(email required if using paystone)
   
Card Holder Name
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Credit Card #
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Expiry Date (mm/yy):
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Credit Card Verification Number
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Example
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Signature of Consent
I authorize the pharmacy to charge my credit card to add new prescriptions to my order
       
Signature of Credit Card Holder
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Date:
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Prescription Details
*note we can only ship a 90 day supply
Medication
(example -. Liptior 20mg)
Directions
(example - Take one tablet
once per day)
Quantity Requested
(example - 100 tablets)
   
   
   
   
   
   
   
   
   
   

 
 
Yes
No
I would like the pharmacy to substitute generic drugs wherever possible to save me even more money.
     
Check here if you would like easy open lids (pills are counted at pharmacy and put in an easy open container)
     
Check here if you would like in manufacturers bottles lids ( where possible your prescription will come in sealed container that does not get opened by us prior assured of contents but there may be a small desiccant present. This bottle may or may not be childproof there is no way to specify.)
     
Check here if you would like child proof containers(for families with small children, you must line up the arrows and pop off the top)
 
* There is a flat rate shipping fee of $9.95 dollars U.S. charged on each order which covers up to $700 worth of goods( Members of the same household can combine orders).

 

   
attach prescription here