Re-order your birth control here. You must have a prescription on file with us to use this form. To renew or for a new prescription, or to receive the birth control shot (Depo-Provera), please book an appointment by calling 1-800-265-7293. All fields marked with a “*” must be filled out in order to process your order. Pick-up times are during office hours. Offices are closed on holidays. Please check our website homepage under “News” for details. For Guelph (Chancellors Way), Fergus and Orangeville We will fill your order within 3 business days. We will hold your order for 7 days. For Shelburne Please call (toll-free: 1-800-265-7293) before you come to pick up your order. We will fill your order within 3 business days. We will hold your order for 14 days. First Name * Last Name * Phone Number * Email Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Name of Birth Control * - Select -Alesse 28EvraDemulin 30Linessa 28LOLOMarvelon 28Micronor 28Minovral 28NuvaringTri-cyclen Lo 28Triquilar 28Yasmin 28Yaz Number of Months Requested * Location of Pickup * - Select -Chancellors WayFergusOrangevilleShelburne CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions.