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Gender:
MaleFemale
First name:
(E.g.: Lynn)
Last name:
(E.g.: Smith)
Email:
(E.g.: lynn.smith@email.com) Personal and confidential information about your health will be forwarded to this email address. Please ensure you alone have access to the mailbox connected with this email address.
Address (number, street, apartment):

City:

Province:

Postal code:
(E.g.: H1W3M6)
Date of birth:

First phone number:
(E.g.: 514-919-5555)
Second phone number:
(E.g.: 514-919-5555)
Language of correspondence:
FrenchEnglish
I'm signing up, after visiting a Halte santé at a participating store:
YesNo
Security question:
The security question and its answer will be of use to you if you forget your password.
Answer to the security question:

Enter a password:
Your password must have at least 8 characters, including both digits and letters. Note: Your password is case sensitive!
Please retype your password:

I have read, understood and agree to the terms of use of the website.

IMPORTANT

To take advantage of the online renewal request service as soon as you've completed your registration, you must have the access card your pharmacist handed you in hand.

Please note however that it is possible to complete the registration now and add the online renewal request service at a later time.

To access your online services, please complete the following form.

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