Request a Health Record transfer^*

When you choose to transfer your Health Record and prescriptions to a pharmacist owner affiliated with Familiprix, you will benefit from the following advantages:

Online renewals using an image of your prescription
Automatic prescription renewals
A pharmacist is available when you need a consultation
Make an appointment online for health services offered at your local Familiprix
Access your online Health Record 24/7

Please fill out the form.
Your new pharmacy will contact you by telephone.
Your file has been transferred!

Transfer My Health Record to this pharmacy

Suggested store

Nathalie Cloutier

Pharmacist owner affiliated with Familiprix

4105, Rue Principale

St-Cyrille-De-Wendover, QC, J1Z1C7

(819) 397-6066

Modify my selection

Personal information

First name

Last name

Birth date

Gender

Contact

Telephone number

ext.

I am aware of the pharmaceutical services offered by the pharmacy mentioned above. I agree to transfer my prescriptions. I was not coerced into making this decision.
I understand that this form, authorizing my consent, will be sent to my current pharmacist.
I remain free to change pharmacy at any time if I am no longer satisfied. In the event of change, this authorization will no longer be valid.

Request a Health Record transfer*

Request a Health Record transfer^*