Order Forms



CanaRx Services Inc. can only process fully completed Enrolment Forms with VALID prescriptions from the primary treating physicians.

The medication(s) you order will be delivered directly to the address listed on your Enrolment Form by the filling Pharmacy within 15-20 days.

If you require medication urgently, please obtain them from your local pharmacy.


   Click on selection below:



New Customer Enrollment Form


Existing Customer Refill or New Rx
If you cannot download these documents, please call us at 1-866-893-6337 or click the link below to request a complete Enrolment Form by mail or fax.

Mail or Fax Form Request


Order Forms
Disclaimer:   CanaRx Services Inc. facilitates the delivery of prescribed medically necessary medication(s). Supervision of your specific medical conditions is monitored by your U.S. physician.
The prescribed medication(s) will only be sent to you following enrollment in our program and after receiving a complete Enrollment Form, your Personal Confidential Profile, and a valid prescription from your U.S. physician.
CanaRx Services Inc. is dedicated to providing all U.S. residents with the opportunity to acquire the highest quality prescription medications at the lowest possible cost.
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