• [email protected]
• Mississauga, ON
• Contact Us

Office Use Orders - TrioLab

• Home
• Office Use Orders

Office Use Orders Form

Health Care Professional Name:

License Number:

Provincial Jurisdiction: SelectAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon

Health Profession:

Clinic Name:

Mailing Address:

Medication/Device Names:

Quantity:

Contact Phone Number:

Contact Email:

Message

*All Orders will Be verified by phone by our pharmacy team.
*Trio Compounding Lab & Pharmacy reserves the right to reject any order.