Consent and Authorization for Community Care Pharmacy Inc. O/A MyEasyDose.ca

 

For a downloadable version of our consent form please click here: Consent Form

 

Please do not fill out this form if you have not spoken to our pharmacy team. To book an appointment to discuss your medications please call 1-855-962-5198 from 9 am – 5 pm Monday – Friday or book an appointment here Thank You!

Patient Info


Parent/Guardian information if the patient is under 16 years of age (Leave blank if over 16 years of age)

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