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Medical History

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1 Are you allergic to any medications?

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Medical History

Information about your health and previous treatments

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2 Do you currently take any prescription or over-the-counter medications?

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Medical History

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3 Is there anything important for the doctor to know about your health?

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You can find your Personal Health Number (PHN) on the back of your British Columbia driver's licence, usually printed near the barcode section.

MSP Card

Please provide your Personal Health Number (PHN)

Where do I find PHN number (Personal Health Number)?

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I do not have a PHN Card

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Upload your ID

Please upload a photo of your government-issued ID card that shows both your image and date of birth

Identification
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Upload a photo of your face

We are responsible for ensuring that your identification is appropriately verified before providing any pharmacy service that requires accessing, collecting, using, or disclosing personal health information.

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your image
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Your Medication

Select your medication

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Select your medication

    • Sildenafil (Generic alternative to viagra)

      • Tadalafil (Generic alternative to cialis)

        • Vardenafil (Generic alternative to levitra)

        *Pharmacy dispensing fee of $10 will be added on top of total charges.

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        Your Medication

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        Preview your information

        Medical history

        Medical history
        Do you have allergies to any medications?

        Your answer: 
        Do you currently take any medications, vitamins or supplements?

        Your answer: 

        Is there anything specific you want your doctor to know about your condition or health?

        Your answer: 

        Personal details

        Medical history

        Name: Date of Birth: Gender: Address: Province: Postal Code:

        Shipping Address Address: City: Province: Postal Code:
        Phone Number: PSN Number: Email:

        Personal Identity Detail: Upload Prescription

        Your uploaded face image: Upload Prescription

        Your Medication

        Medical history

        Your selected medication: Selected strength: Selected quantity: Selected: $ Fixed fee: $10

        No Medication:

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        Your Medication

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        Dr. Daniel Obaseki [English]
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        Nadine Power NP(F) [English]
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        Dr. Rolf Major [English]
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        Dr. Mohammad Reza Nakhaei [English, Farsi]
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        Jacqueline Kennedy NP(A) [English]
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        Dr. Azzam Azzam Azmy [English]
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        Virginia Burns NP(F) [English]
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        Dr. Javad Ramezani [English, Farsi]
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        Dr. Magdy Mourad Farag Attalla [English, Arabic]
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        Dr. Ifeoluwa Osinowo [English]
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        Monica Anderson NP(F) [English]
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        Dr. Chimdimma Favour Eze [English]
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        Dr. Oluwasola Stephen Ayosanmi [English]
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        Dr. Arman Singh [English]
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        Dr. Deepak Murthy [English, Hindi]
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        Dr. Omosomi Esebameh [English]
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        Dr. Clement Belanger Bishinga [English, French]
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        Rachel Slomp NP(F) [English]
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        Fereshteh Shahmiribozorgi NP(F) [English, Farsi]
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        Dr. Mina Antonious [English]
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        Dr. Shideh Faghih [English, Farsi]
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        Dr. Farshad Nokam [English, Azeri, Farsi]
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        Sean Young NP(F) [English]
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        Dr. Osa Olayemi [English]
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        Dr. Lidya Habbeb ishaq Sanjaqli [English]
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        Transfer refills quickly and easily

        ED can request your prescription from another pharmacy.

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        Transfer refills quickly and easily

        Request prescription from

        Pharmacy Name:

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        Medical History

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        Your Medication

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        Name: Email: Date of Birth: Gender: Address: Province: Postal Code:

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