Patient Intake

Start Your File with Hogan Pharmacy

We’ll create your patient file and transfer your current medications to our store. Please fill out the form below with your details so we can get everything set up for you.

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Location

Location*

Patient information

Patient Name*

Patient Phone Number*

Patient Email Address*

Patient Address*

Street Address City Postal Code

Patient Date of Birth*

Health Card Number

Drug Allergies*

Medical Conditions*

Current Pharmacy

Store Name*

Store Phone*

Serving Lambton County for 70+ years, from our origins at St. Josephs to today near Bluewater Health, we’re your dedicated partner in wellness.