If you have had an appointment at the Newman Breastfeeding Clinic within the last 6 months and would like a refill of a medication one of our pediatricians prescribed to you or your baby, please fill out the request form below. A prescription refill charge of $10.00 is requested via Paypal.  The refill will be faxed directly to your pharmacy.  


If you have not had an appointment at the clinic in the last 6 months, we may not be able to provide a refill. Please email your request to admin@ibconline.ca.

    Breastfeeding Parent's First Name (required)

    Breastfeeding Parent's Last Name (required)

    Baby's First Name

    Baby's Last Name

    Phone (required)

    Email (required)

    Date of Last Appointment at Newman Breastfeeding Clinic (required)

    Medication Name (required)

    Dose (number of pills/ amount/ times per day) (required)

    Your Pharmacy Name (required)

    Your Pharmacy Address (required)

    Your Pharmacy Fax Number (required)

    Thank you! You will be redirected to Paypal to confirm the $10.00 fee for prescription renewal and contacted by email to confirm your prescription renewal.