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 *

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.

We text you when your refill is ready for pick up. We also have the ability to text you a remote payment link, so you can pay ahead of time and make your check out experience faster. Would you like to receive a remote payment link as well?

Yes No

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.

You will receive a text when your prescription is ready to pick up, followed by a remote payment link. You can use this remote payment link to make your pick up faster and more efficient!