Prescription Form Test Page - Walk in Clinic Winnipeg, Marion Medical Centre

Non-Urgent Walk-In Status
WALK-INS CURRENTLY ACCEPTED

Marion Medical Centre 172 Marion St, Wpg, MB R2H0T4

204-231-1900

Monday and Tuesday & Thursday - 8:30 A.M- 8:00 P.M
Wednesday & Friday - 8:30 A.M- 5:00 P.M
Saturday & Sunday - Closed
-

Our Hours

Click here to see our hours

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Order Prescription Refills Here!

Note: We do not ship medication outside of Canada.

Free 30 minute parking while filling your prescription!

Name(Required)

First Last

Phone Number(Required)

Email

What is the best way for us to contact you?

Phone

Email

Are you an existing customer of Marion Medical Centre?

Yes

No

Are there any changes to your address, allergies, insurance information or your health?

Yes

No

Update Address

Address Buzz code City Province Postal code

Leave blank for no changes.

Describe allergies, insurance coverage or health changes:

Address(Required)

Address Buzz code City Province Postal Code

Is this prescription refill or new prescription?

New Prescription

Prescription Refill

Prescription Refill

1 - Prescription Refill Number or Medication Name(Required)

1 - Refill Quantity(Required)

Please enter a number greater then or equal to 1.

1 - Refill More(Required)

+

-

2 - Prescription Refill Number or Medication Name(Required)

2 - Refill Quantity(Required)

Please enter a number greater then or equal to 1.

2 - Refill More(Required)

+

-

3 - Prescription Refill Number or Medication Name(Required)

3 - Refill Quantity(Required)

Please enter a number greater then or equal to 1.

3 - Refill More(Required)

+

-

4 - Prescription Refill Number or Medication Name(Required)

4 - Refill Quantity(Required)

Please enter a number greater then or equal to 1.

4 - Refill More(Required)

+

-

5 - Prescription Refill Number or Medication Name(Required)

5 - Refill Quantity(Required)

Please enter a number greater then or equal to 1.

New Prescription

Upload prescription(s)(Required)

Note: Original prescription is required by pharmacy. Will only fill the prescription when receiving the Original.

Drop files here or

Accepted file types: pdf, jpg, png, Max. file size: 5 MB.

Transfer Prescriptions Information

Is there a prescription that you would like to transfer from another pharmacy?(Required)

Yes

No

How many prescriptions do you need to transfer?(Required)

1 - Where was your Prescription Filled?(Required)

Name and street of pharmacy

1 - What is your Prescriber's Name?(Required)

1 - Name or Prescription Number of Medication(Required)

1 - Pharmacy Telephone Number

2 - Where was your Prescription Filled?(Required)

Name and street of pharmacy

2 - What is your Prescriber's Name?(Required)

2 - Name or Prescription Number of Medication(Required)

2 - Pharmacy Telephone Number

3 - Where was your Prescription Filled?(Required)

Name and street of pharmacy

3 - What is your Prescriber's Name?(Required)

3 - Name or Prescription Number of Medication(Required)

3 - Pharmacy Telephone Number

4 - Where was your Prescription Filled?(Required)

Name and street of pharmacy

4 - What is your Prescriber's Name?(Required)

4 - Name or Prescription Number of Medication(Required)

4 - Pharmacy Telephone Number

5 - Where was your Prescription Filled?(Required)

Name and street of pharmacy

5 - What is your Prescriber's Name?(Required)

5 - Name or Prescription Number of Medication(Required)

5 - Pharmacy Telephone Number

Additional Information

Comment or Special Instructions

Type(Required)

Pick Up

Delivery

Delivery Time(Required)

1:00 PM - 6:00 PM

6:00 PM - 10:00 PM

Please confirm for delivery

Consent(Required)

I confirm the address, buzz code, and phone number are correct.

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We would love to hear from you about our patient services, what we are doing good and what to improve. Please share your suggestions or leave a testimonial.

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Hours of Operation

Monday and Tuesday & Thursday

8:30 A.M- 8:00 P.M

Wednesday & Friday

8:30 A.M- 5:00 P.M

Saturday & Sunday

Closed

Hours may vary on weekends and statutory holidays. Please call in advance to confirm.

Useful Links

Pharmacy
Family Practice
Walk in Clinic
Dermatology
Immunizations
Uninsured Services
Patient Policies
Contact Us

Contact Us

172 Marion St, Wpg, MB R2H0T4

info@marionmedicalcentre.ca

204-231-1900 (Phone)

204-231-8100 (Fax)

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About
Services
Uninsured Services
Pharmacy
Recognitions
Contact
Book an Appointment

About
Services
Uninsured Services
Pharmacy
Recognitions
Contact
Book an Appointment

About
Services
Uninsured Services
Pharmacy
Recognitions
Contact
Book an Appointment