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:
  

Last Name:
         
Address:
         
City:
  
State:
         
Country:
  
Zip:
         
Telephone:
  
Alternate Telephone:
         
Fax:
  
Email:
         
Birth date:
(dd/mm/yy)
  
Gender:

B) PAYMENT INFORMATION (VISA or MasterCard #)

(email required if using paystone)
   
Card Holder Name
   
Credit Card #
         
Expiry Date (mm/yy):
      
         
Credit Card Verification Number
      
         
Example
 

 

Signature of Consent
I authorize the pharmacy to charge my credit card for the over the counter medications I have requested
       
Signature of Credit Card Holder
Date:

 

OTC ITEMS
Medication
(example -Prodiem)
Size
(example - 400 gram)
Quantity Requested
(example - 100 tablets)
   
   
   
   
   
   
   
   
   
   

*Please note you do NOT need to include a copy for your prescription for refills *