VTE Antithrombotic Therapy Requisition - CALGARY

SRx Pharmacy, open 9am-5pm Mon-Fi

Phone: 403-286-0013           Fax: 403-286-0018

4525 Monterey Ave NW, Suite 260

Complete our online form and we will provide treatment for your patient.  All data is encrypted and highly secure.  Furthermore, we will collect identifiers when the patient contacts us.

If you prefer, you can scroll down for the pdf version which you can print, fill out, and fax to the pharmacy.