Prescription/Food Refill Request Form

Prescription/Food Refill Request Form
In general, prescription refills should be available within 48 hours, unless it is a special order item. If you need these medications sooner, please call.

Please fill out a separate refill request form for each pet.
Date of Refill Request *

Month Day Year
Date
Client's Name *

First Name Last Name
Pet's Name *
Cell Phone Number *
We text you when your refill is ready for pick up.

Medication refills requested (Medications only should be requested here, food is separate. If not requesting any medications, write "none" in one cell) *

	Medication Name	Strength (mg, mg/ml, etc)	Quantity Requested**	How are you giving/dosing this medication at home?
1
2
3
4
5
6

Food refills requested (Foods only should be requested here, medications are separate. If not requesting any foods, write "none" in one cell) *

	Food Name	Bag size (in lbs) or can size (in oz)	Quantity Requested**
1
2
3
4
5
6

**Please be aware if you request a different quantity than what your prescription was originally written for, this may cause delays in your refill as it will have to be okayed by a doctor**
Special instructions/requests
Please be prepared to pick up your medication/food within 3 days of it being filled. After 10 days, items will be reshelved.
Should be Empty: