How many prescription pads would you like to order? *

Please note that each pad contains apx. 50 sheets.
 
What's your full name? *

 
Name of your organization or practice: *

 
Phone number? *

 
Now the shipping details...

 
What's your street address? *

 
Postal Code? *

 
City & Province? *

 
{{answer_37433833}}, which shipping method would you prefer? *



 
How do you think these prescription pads will be helpful to you and/or the people you serve?

(Optional)
Thank you for your order, {{answer_37433833}}!
We'll follow up soon.

Should you have an immediate question, please email us at nccid@umanitoba.ca
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