Dauphin Clinic Pharmacy

Prescription Refill Online Form

* First Name:

* Last Name:

* Date of Birth

* E-mail Address:

* Phone:

Cell:

Address:

Postal Code:

* Prescription Number(s) or Medication Name(s):

* Delivery Type

Pick-up

Delivery

Courier

Mail

Payment Type

Cash

Debit/Credit

Other

Sometimes recipient mail servers temporarily delay or block messages, or other technical issues could arise prohibiting your order from reaching our pharmacy. Please phone us at 204-638-4602 if you don't receive your order when you expected it.

Contact Us

622 3rd Street SW
Dauphin, Manitoba, Canada, R7N 1R5
x 204-638-4602    TF 1-888-638-5930
x After Hours: 204-638-2778    A dcp@mymts.net
G 204-638-3140    G 204-638-4390

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