Important note:

If there are no refills on file, your request will need to be authorized by our veterinarians. This may take up to a week. We require a valid veterinarian-patient-client relationship, including annual physical examinations, for medication to be prescribed. We reserve the right to decline medication refills when examination and testing protocols have not been followed.

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Name *

First

Last

Email *

Pet name? *

Please select your products(s)

• Prescription diet
• Maintenance diet
• Prescription pharmaceutical medication
• Prescription herbal or nutritional supplement
• Prescription homeopathic medication
• Other

Please select how quickly it is required: *– Please select –Urgently! I’m completely out and need it today. I understand there will be a $15 urgent refill fee added to the invoice.In a few days (4-7 business days advance notice)Next week (Way to go, you are planning ahead!)

1st Product: name and details (size/strength) *

Please give as much detail as possible, eg tablet size in mg;

Rx Number on product dispensing label

Rx# is found on the top of the item’s hospital dispensing label to the left of the date

Amount/size required? *

Please specify number of tablets, size of bottle in ml or grams, or number of vials or ampules

Additional product (if any) name and details (size/strength)

Please give as much detail as possible, eg tablet size in mg;

Rx Number on product dispensing label

Rx# is found on the top of the item’s hospital dispensing label to the left of the date

Amount/size required?

Please specify number of tablets, size of bottle in ml or grams, or number of vials or ampules

Additional product (if any) name and details (size/strength)

Please give as much detail as possible, eg tablet size in mg;

Rx Number on product dispensing label

Rx# is found on the top of the item’s hospital dispensing label to the left of the date

Amount/size required?

Please specify number of tablets, size of bottle in ml or grams, or number of vials or ampules

Additional products requested

If more than 3 products are being requested, please list additional products here, and include Rx number, number of tablets, grams, ampules, vials or volume in ml

How is your pet doing on their prescribed treatments? *

We’d like to make sure that your pet has been responding well their prescribed therapy. Please let us know if you have any questions or concerns.

Checkboxes

• First Choice
• Second Choice
• Third Choice

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