Order Request Form

Order Request Form

Lifetime Pet Centers of New Richmond & Williamsburg
Use this form to place an order for pick-up from the hospital of your choice. Please be sure to include all of the information requested and note which hospital you will need to pick-up from. A staff member will contact you when your item is ready for pick-up via your preferred method of contact.

Want to make ordering your pet's diets and medications easier? Download our app to place orders, schedule appointments, view your pet's medical and vaccination records, and access our new loyalty program! Be sure to use the same email as the email on your account through our system.

*Please note: anything that is a special order or not currently in stock may take anywhere from 2 to 7 business days to arrive depending on when you submit your request.*
Your Name/ Main Name on your Pet's Medical Record *

First Name Last Name
Pet's Name *
Phone Number *

Area Code Phone Number
Email
example@example.com
How do you prefer to be contacted with questions and/or when your order is ready? *

Phone Call Text Message Email
Do you need to refill a medication, regular diet, prescription diet, or something else for your pet? *
Upload a photo of what you need if you don't feel like writing it out!

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List what you need below:
Please be sure to include as much information as possible including the name of the item, size/amount requested, and any other information you think is important. We will contact you if you if we have any questions via the preferred communication method above.
Should be Empty: