UPLOAD PRESCRIPTION | REFILL REQUEST Please fill out the following form to submit a new prescription and/or refills for review. Our team will be in touch with you within 1 business day. Birthday (required) I acknowledge and agree that the information provided in this form is not for urgent medical matters. I understand that Platinum Compound Rx Pharmacy will use my information only to respond to my inquiry in accordance with Manitoba’s Personal Health Information Act (PHIA). I consent to the collection, use, and storage of my personal information as described in the Privacy Policy. Δ