New Prescription Request – Medzone Mettra Pharmacy

By filling out this form, you are giving us consent to collect, access, and use your personal information which will allow us to process your prescription refills.

First Name *

Last Name *

Date Of Birth *

Contact Number *

Email *

Please Upload a Photo of Your Prescription

Please make sure to bring the original prescription to the pharmacy.

How Would You Like to Get Your Prescription? *

Pick-Up Delivery

Pick-up Instructions

Please pick up your prescription at MEDZONE METTRA PHARMACY
3680 E Hastings Vancouver BC V5K 2A9.

Monday to Friday 8:00AM - 4:30PM

IMPORTANT: The original prescription must be presented at the pharmacy.

Select Time And Date of Pick-up *

Pickup Date *

Pickup Time*

*PLEASE NOTE: We will contact you to discuss time of delivery and other details.

Delivery Address: *

Additional Information