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Calendar of Events
Island Foot Care
Synthroid Info
VitalAire
Healthy Habits
FAQ
Web Links
Medication Packaging
Donations
Flu Shots - Seasonal Influenza
Prescription Mail Order

Enroll in our free delivery services for your prescriptions. If you would like your medications mailed to you, please fill out the form below. There is no obligation or fee to enroll in our prescription home delivery service. Simply tell us who you are, where you would like your order sent, and how you wish to pay for the prescription.

If you have additional questions about your enrollment or your medication needs, you can also call us at 1-902-368-2004.

Please note fields marked with an asterisk (*) are required.

Your Personal Information
First Name (*)
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Last Name (*)
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Date of Birth (*)
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Sex
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Provincial Health Number (*)
Please provide your up to date provincial health number. Your prescription cannot be filled without this information.
Do you have any allergies?
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If yes, please list your allergies below.
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Please list any medical condition(s) below.
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Delivery Address Information
Street (*)
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Suite or Apt. Number
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City (*)
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province (*)
Please select your Province of residence
Postal Code
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Contact Information
Home Phone (*)
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Work Phone
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Cell Phone
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Email
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Insurance and Billing Information
Do you have private insurance?
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Private Insurance Provider
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Other private insurance provider
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If you have any special delivery requirements, please enter them here.
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Payment Options
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A member of the Friendly Pharmacy team will contact you to confirm your information.

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