Prescription Refill Form

Please complete the below form to refill your prescription. The Prescription Shop at St. Joseph's Hospital will inform you when it is ready for pick-up. If you have questions, please contact:
 
Prescription Shop
St. Joseph's Hospital
Room A1-013
268 Grosvenor Street
London, Ontario
N6A 4V2
 
Hours: Monday to Friday 9 a.m. to 5:30 p.m.
Closed weekend and statutory holidays (including Remembrance Day)
Phone:  (519) 646-6100 (ext. 66194)
Fax:  (519) 646-6202
 
This personal information is being collected under the authority of the Public Hospitals Act R.S.O. 1990, CHAPTER P.40 for the purpose of contacting the sender in response to an inquiry. If you have questions about the collection of this information, please contact a Privacy and Freedom of Information Consultant, St. Joseph's Health Care London, 268 Grosvenor Street, London, ON,519-646-6100 ext. 61418.

Please Note:

Your refill will be ready to pick up in one business day. For special pick up requests, please provide instructions to the Prescription Shop team below and we will do our best to accommodate your requirements:

Personal information submitted within this form is collected under the authority of the Public Hospitals Act R.S.O. 1990, CHAPTER P.40 for the purpose of responding or contacting the sender in response to an inquiry. If you have questions about the collection of this information, please contact a Privacy and Freedom of Information Consultant, St. Joseph's Health Care London, 268 Grosvenor Street, Room B2-234, London, ON, N6A 4V2. Phone: 519-646-6100 ext. 65591.