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

Sarah-Kim Lachance

Pharmacist owner affiliated with Familiprix

33, Boul Ste-Anne Ouest

Ste-Anne-Des-Monts, QC, G4V1P8

(418) 763-7848

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^*