Language
English (US)
Prescription Refill Request
Please allow at least 24 hours for refills. Requests received over the weekend may not be filled until the following business day.
Pet Name
*
Owner's Name
*
Owner's Phone Number
*
Owner's Email address
*
Which veterinarian prescribed the medication?
*
Doctor's Name
How would you like your prescription filled?
*
Pick up at Capital Vet Specialists
Call into Pharmacy (please provide pharmacy name and phone # below.
Pharmacy Name:
Pharmacy phone number:
-
Area Code
Phone Number
Medication (s) to be refilled.
*
Include medication name and strength ex: 50mg
Medication (s) to be refilled.
Include medication name and strength ex: 50mg
Medication (s) to be refilled.
Include medication name and strength ex: 50mg
Medication (s) to be refilled.
Include medication name and strength ex: 50mg
Comments / Questions
THANK YOU!
You will be called when your prescription is ready to be picked up.
Submit
Should be Empty: