Operating Hours: M-F 9-6pm EST quick search: over 10,000 products Prescription Prices Price Calculator Shopping Cart Current Order 0 items selected Medical Information Personalized Medicine Pharmacogenetic Testing Side Effects Weaning Off Medications Health Topics Bulletins Pharmacy.ca Using This Site About Us Certification Careers Contact Us This site complies with the HONcode standard for trustworthy health information: verify here.   Tamoxifen CYP2D6 Interaction Monitoring Service Items marked with (*) are mandatory. We need some information about you. All information is confidential and will be used only for the stated purpose. Select the desired service: 1st year monitoring - I've had a Tamoxifen CYP2D6 Pharmacogenetic Test and wish to have my other medications monitored for interactions with Tamoxifen for the next year. $130(+GST) cognitive service for 1st year. additional years monitoring as per the above service, available at your option at a price of $180(+GST) per year. SELECT Plan : There is no fee for screening and interactions for all prescriptions filled by Pharmacy.ca. Each time you get a medication filled with Pharmacy.ca we will screen it for interactions with your Tamoxifen therapy. You must complete and sign this Enrollment Form so that we can screen your present medications (at no charge) and so that we recognize you as a Tamoxifen CYP2D6 Interaction Monitoring Service patient when you get future prescription and non prescriptions filled by Pharmacy.ca About Me: First name (*): Middle name: Last name (*): Email address (*): Please provide primary phone number(s) and email address on which you give us permission to call you to discuss your medications and health issues, and on which we may leave a related phone message if unreachable. Phone Number (*): If possible, please provide an alternate phone number where the same conditions apply Alternate Phone Number: Street Address (*): City (*): Province (*): Postal Code (*): Birth Date: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December My current medications: I take no medications Please tell us about all the medications you are current using (include name, strength and frequency) Brand name or generic name Strength (often in mgs) Frequency (how many times you take it per day, when taken as prescribed) Example: Lipitor 20 mg once a day Additional Information or medications you are currently using: Over the counter medications: I take no over-the-counter medications Please list all the over-the-counter medications (non-herbals & non-vitamins) you are currently using and what condition you use them for. Name Strength Frequency What do you use it for? Additional Information or over-the-counter medications you are currently using: Herbals: I take no herbal medications Please list all the herbal medications you are currently using and what condition you use them for. Active herbal ingredient NOT brand Strength (often in mgs) Frequency Additional Information or herbals you are currently using: Vitamins: I take no vitamins Please list all the vitamins you are currently using and what condition you use them for. Name Strength Frequency Additional Information or vitamins you are currently using: Insurance Info: Please note, Inhibitor Screening Service is not a covered insurance benefit, however we ask for your 3rd party insurance information to aid in providing you pharmacy prescription services should you elect to get your prescriptions from Pharmacy.ca. Insurance Company: First Name of Insured: Last Name of Insured: Your relationship to insured: (spouse, son, daughter, self etc.): Carrier: HealthPlan/Group ID#: Patient ID#: Where did you hear about pharmacy.ca: Please tell us where you found out about pharmacy.ca Other things you want to tell us: Patient Consent: By clicking the "Submit" button below, I am consenting to allow Pharmacy.ca to share my health as necessary with physicians whom prescribe for me and/or physicians whose care I am under. I further consent for Pharmacy.ca to share my health and insurance information with my insurer to the extent reasonably necessary to obtain or seek to obtain insurance coverage for any prescription medications I elect to get from Pharmacy.ca. I am providing my credit card information and consenting to allow Pharmacy.ca to bill my account for the Tamoxifen CYP2D6 Interaction Monitoring Service for the first year at the rate described above. I understand that any future charges on my card related to ongoing interaction monitoring in subsequent years will only be charged once I have given my verbal authorization at that time. I further understand that there is no charge on my card to have interaction monitoring done on any prescriptions I have filled by Pharmacy.ca. Note: Upon submitting you will be taken to a secure page where you can input your credit card information to complete the sale. | home | prescriptions | non-prescription medicine | vitamins, herbals & nutrition | personal care | | allergy medicine | excessive sweating| arthritis | smoking cessation | hair loss | back pain | medical tests | 311 Sherbourne St, Toronto, On M5A 3Y1 1-416-960-7768 OCP Accreditation number 17533, owner is Central Medical Pharmacy Inc. Designated manager is Veronique Koo, B Sc Phm. Pharmacists are available for counselling during operating hours. 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