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New Pharmacy Patient

New Pharmacy Patient Registration

Sign up as a new patient at our pharmacy.

Join us today and let us take care of your WHOLE health!

Thank you for making My Whole Health Pharmacy your provider of choice for quality medicines and services. To make the most out of our services, we recommend that you register as a new pharmacy patient by filling out the form provided below.

    First Name: (required)

    Last Name: (required)

     

    Date of Birth: (required)

    Your Phone Number: (required)

    Your Email: (required)

     

    Your Full Address: (required)

    City: (required)

    Postal Code: (required)

     

    Do you have any allergies? (required)
    YesNo

    Allergies – List all your known allergies:

     

    Current Medications: (including over-the-counter and herbal)

    Medical Conditions – Let us know of any medical conditions we should be aware of

     

    Select the location of the pharmacy:

     

    Do you have insurance? (required)
    YesNo

     

    Insurance Card – If you have insurance take a picture of your insurance card and upload it here




    My Whole Health Pharmacy group is an independently owned and operated pharmacy with convenient and easy to access locations in Mississauga, Brampton, Oshawa, Welland, and North York.


    ©2021 by My Whole Health Pharma Inc. All rights reserved.
    Website Designed by Intact Marketing



    ©2021 by My Whole Health Pharma Inc. All rights reserved.
    Website Designed by Intact Marketing