VTE Antithrombotic Therapy Requisition - CALGARY

drug + bean, open 8am-4pm Mon-Fri*

Phone: 587-356-3786           Fax: 587 356 3787

Suite #120, 2210 2nd street SW

*Home Visits offered 5-10pm Mon-Fri.  If referring a patient outside of operating hours, please phone Steve at 587-891-8808 or Shaheena at 647-949-8507 to confirm receipt of form.

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.

Online requisition currently unavailable
PDF Version for download: