Hillside VH - Prescription Refill Request

Running low on medication? Get your pet's prescriptions refilled! Use the form below and a member of our team will get your order filled. NOTE: PLEASE ALLOW 24 HOURS FOR ALL MEDICATION REFILLS AND 5-7 BUSINESS DAYS FOR SPECIAL ORDER MEDICATIONS. If you need immediate assistance, please give us a call at 250.598.4477.

CLIENT NAME ON FILE: *

First Name Last Name

CLIENT PHONE # ON FILE: *

PET'S NAME: *

DRUG: *

DRUG STRENGTH: *

QUANTITY REQUESTED: *

HOW OFTEN ARE YOU GIVING THIS MEDICATION (FREQUENCY): *

HOW IS YOUR PET DOING?

WHEN DO YOU NEED THIS MEDICATION BY?

DO YOU HAVE AN ADDITIONAL PRESCRIPTION REQUEST? *

Yes No

DRUG: *

DRUG STRENGTH: *

QUANTITY REQUESTED: *

HOW OFTEN ARE YOU GIVING THIS MEDICATION (FREQUENCY): *

WHEN DO YOU NEED THIS MEDICATION BY? *

DO YOU HAVE AN ADDITIONAL PRESCRIPTION REQUEST?

Yes No

DRUG: *

DRUG STRENGTH: *

QUANTITY REQUESTED: *

HOW OFTEN ARE YOU GIVING THIS MEDICATION (FREQUENCY): *

WHEN DO YOU NEED THIS MEDICATION BY? *

*Please note - due to high demand, orders may take longer than usual to arrive. We cannot guarantee a pick-up date.

ADDITIONAL COMMENTS:

Please verify that you are human: *