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Please complete the form to upload a new prescription or request a refill.
Prefer to speak with us directly? Call us at 519-434-5333 — we’re happy to help!
New or Refill Rx form
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Patient First Name
*
Patient Last Name
*
Patient Date of Birth
*
Patient Phone Number
*
Prescription Type
*
Select one
Refill your existing Prescription
Submit a New Prescription (upload required)
Pickup or Delivery?
*
Choose one
Pickup
Delivery
Select Your London Medical Pharmacy Location
*
Please choose a branch closest to you
LMP Adelaide - 1135 Adelaide St N, London
LMP Downtown - 528 Dundas St, London
LMP Bradley - 595 Bradley Ave, London
LMP Clarke - 1892 Dundas St, London
LMP Advantage Care - 1617 Dundas St, London
LMP Huron - 1472 Huron St, London
LMP Base Line - 25 Base Line Rd W, London
Delivery Address
*
Upload New Prescription
*
PDF or image, up to 10 MB.
Prescription Numbers
*
Submit Refill Request
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