Prescription Refill Request Form

Please use the form below to request your prescription refill item(s). This will save you time when picking up your order. Please allow at least 48 hours for order processing. Do not come to the clinic until you have received confirmation to pick up your order.

If you are concerned that you will run out of medications before hearing back PLEASE CALL US instead of using this form.

Many prescriptions require your pet to be examined before dispensing. This ensures that your pet is healthy enough to handle the potential side effects of some prescriptions and provides further confirmation that the medication is appropriate for your pet’s current condition.

IMPORTANT: Prescription Refills are not confirmed until you have received notification. A staff member will contact you by phone or email.

Name*
First Last
Email*
Phone*
Pet Name*
Drug or Food Name*
Medication (list)*
Current dosage as prescribed (itemized list):*
___ units every ___ hours for ___ days. I have ___ doses remaining in the current prescription.
Additional Comments*
I have another Prescription Request (check the appropriate box):*
- Yes
- No
Drug or Food Name*
Medication (list)*
Current dosage as prescribed (itemized list):*
___ units every ___ hours for ___ days. I have ___ doses remaining in the current prescription.
Additional Comments*
I have a third Prescription Request (check the appropriate box):
- Yes
- No
Drug or Food Name*
Medication (list)*
Current dosage as prescribed (itemized list):*
___ units every ___ hours for ___ days. I have ___ doses remaining in the current prescription.
Additional Comments*