VTE Antithrombotic Therapy Requisition - LETHBRIDGE

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Medicine Shoppe #127, 1016A - 20 St South, Open 8:30am-6pm Mon-Fri and 10am-2pm Saturday

Phone:  403 380 3282       Fax: 403 380 3426

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This service is available 24 hours.  If submitting after store hours, confirm receipt of requisition by calling Vishal Sukhadiya at 403-715 0021.

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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.

PDF Version for download