Agree to the "Power of Attorney" and fill out the "Patient Questionnaire" forms by selecting an option below:

ONLINE Power of Attorney and Patient Questionnaire
OR
FAX The Power of Attorney and Patient Questionnaire
(to be completed and sent to us)

 

Fax or Mail us your prescription, "Power of Attorney" and "Patient Questionnaire" forms. If you have chosen to fill the forms online, then you need only to send us the prescription.

If you do not have your original or a copy of your prescription, please provide CanTrustRx with your physician's name, telephone and fax number. Our staff will contact your doctor directly and request a copy of the prescription.

Fax:
1-800-640-5553

Mail To:
CanTrustRx Pharmacy
7 - 2 Donald Street
Winnipeg, Manitoba
Canada
R3L 0K5