New Pharmacy Patient - Register with ScaleRx

First Name: (required)

Last Name: (required)

Date of Birth: (required)

Your Phone Number: (required)

Your Email: (required)

Your Full Address: (required)

City: (required)

Postal Code: (required)

Do you have any allergies? (required)
YesNo

Allergies – List all your known allergies:

Current Medications: (including over-the-counter and herbal)

Medical Conditions – Let us know of any medical conditions we should be aware of

Select the location of the pharmacy:

Do you have insurance? (required)
YesNo

Insurance Card – If you have insurance take a picture of your insurance card and upload it here

ScaleRx is an independently owned and operated pharmacy with convenient and easy to access pharmaceutical solutions.

Unit 400 2620 Bristol circle
Oakville On L6H 6Z7
905-291-7970
1-833-333-1435

New Pharmacy Patient Registration