Submit a Referral Online | Miracle Prescriptions North Vancouver

Your details

Your name

I am a...

Phone number

Email (optional)

What do you need?

Service of interest

Patient's neighbourhood (optional; helps us plan routes)

Anything else we should know? (no health numbers or medical details, please)

I understand this form is for contact purposes and that clinical information will be collected by phone or fax.

This form is delivered to miracle@mintdrugs.com. Please do not include personal health numbers, diagnoses, or medication lists here. Health professionals: clinical referrals with patient documents should be faxed to (604) 770-2035.

Prefer fax or phone?

Referral fax: (604) 770-2035
Phone: (604) 770-2030
Email (non-clinical): miracle@mintdrugs.com

Printable referral form for fax
Fillable PDF referral form

What happens next

We reply within one business day.
Urgent hospital discharges are assessed same day or next day.
The pharmacist calls you or the patient to complete intake by phone.

How it works

Step-by-step guide for families
Referral pathway for health professionals