Due to COVID response, birth control appointments are suspended until further notice. Please contact your primary care provider or make an appointment at a walk-in clinic if possible. Check back later for updates on when this service will resume. 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 appointmentby calling 1-800-265-7293 ext. 7006. 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. First Name * Last Name * Phone Number * Email Date of Birth * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 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.