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 48 HOURS FOR ALL MEDICATION REFILLS AND 5-7 BUSINESS DAYS FOR SPECIAL ORDER MEDICATIONS. Once you have received notification that your refill is ready, please pick up within 14 days.

If you need immediate assistance, please give us a call at 250.598.4477.

CLIENT NAME ON FILE:*

First NameLast 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?*

YesNo

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?

YesNo

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:*