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EJM PHARMA – Pharmacie El-Achkar, Jetha et Merrouni

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Order Form

Step 1: Select your products

If the product you are looking for is not in the scrolling choices, please enter it manually.

Product Quantity

Step 2: Prescription information if necessary

Prescription

If the compounded solution is for a patient, join a copy of the prescription. Make sure to black out personal informations for a confidential transmission.

QUICKLY ADD A SCREENSHOT OF THE PRESCRIPTION HERE

Open the prescription scan. ENLARGE THE PRESCRIPTION ON SCREEN AS MUCH AS POSSIBLE SO THAT IT IS CLEARLY READABLE. Then ⊞ Win + SHIFT + S and select the area to copy. Paste CTRL + V into this section.

Renewal

For a renewal, enter the prescription number of our EJM pharmacy if you have it on hand.

Insurance and Delivery

The RAMQ pays the cost of transport of covered preparations from the compounding pharmacy to the dispensing pharmacy for the patients covered under this regime. If applicable, please check RAMQ and enter the prescription number at your pharmacy. If the product is for multiple patients, only one prescription number is sufficient.

Step 3: Your informations

A confirmation of your order or estimation will be sent in the email above.
We will send estimations in the provided fax number. Use the following format: 123-456-7890