103-143073 TR 192
Box 1239 Brooks, AB T1R 1C1
Prior to your first visit please complete this form so that we can effectively and efficiently provide the service you deserve!
This form should only be used for requesting appointments that will take place at least 2 full business days after the time of the submission of this form.
Please use the form above to request your prescription refill or food item. This will save you time when picking up your order. Please allow 24 hours for order processing.