General Prescription Refill Request

AADC Online Prescription Refill Request

Simply request your pet's medication refills here. Need shipped? Just let us know! Want to pick up here in our office - we can arrange that for you! If you would rather place your order with someone at our clinic directly, you can call us at 719-358-2636. Please be aware that medication refills can take up to 5-7 business days and allergen refills can take up to 30 days.
Owner Name*

First NameLast Name
Pet's Name*
Primary E-mail *
Primary Cell Phone Number*

Area CodePhone Number
PLEASE NOTE THAT SPECIAL ORDER MEDICATIONS SUCH AS OTIC GEMISH AND ALLERGEN REQUIRE PRE-PAYMENT AND HAVE LONGER DISPENSE TIMES.

PLEASE ALLOW UP to 5-7 BUSINESS DAYS FOR PHARMACY REFILLS AND 30 DAYS FOR ALLERGEN REFILLS.
Medication #1*
Name and strength (ex: Apoquel, 16mg)
Quantity *
Quantity (ex: 90 tablets)
How often do you give this medication? *
Frequency (ex: I give 5mg tablet twice daily, etc.)
Medication #2
Name and strength (ex: Apoquel, 16mg)
Quantity
Quantity (ex: 90 tablets)
How often do you give this medication?
Frequency (ex: I give 5mg tablet twice daily, etc.)
Medication #3
Name and strength (ex: Apoquel, 16mg)
Quantity
Quantity (ex: 90 tablets)
How often do you give this medication?
Frequency (ex: I give 5mg tablet twice daily, etc.)
How do you want to be notified that medication is ready for pick up or ready to be mailed?*

TextEmail
Please choose the best option for your payment and pickup*

Pickup at your office - Charge my card on file once medication is filledPickup at your office - Will pay at pickup *Custom medications such as Otic Gemish and Allergen require prepayment prior to filling, so this choice is not an option for those medications*Mail to me - Charge my card on file for payment (I understand there will be a shipping fee).Mail to me - Please confirm total with me using above contact method before my charging my card.
Please verify the last 4 digits of your card on file that you authorize us to use. (if paying at pick up, put "none")*
Last 4 digits of card number
Shipping Address (only required if we are shipping your medications to you)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Interested in learning more about and/or signing up for autoship for your pet's medications? Please use the link included on the next page after you submit this form!
By signing, you authorize us to refill your pet's medication, and charge your card on file for any due payment/prepayment as indicated above. *

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AADC Online Prescription Refill Request