In-House Prescription Refill & Food Request
Request for medication to be refilled in office at Ohio County Animal Clinic, PLLC in Hartford, KY. Pick-up at clinic or we can mail medications via USPS for a minimal fee. All food request must be picked up at our clinic.
DateTime
Owner's Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact you if our office has questions
*
Text
Email
Phone Call
Pick-Up or Mail
*
Pick-Up & Pay in Office
Pick-Up in Office & Pre-Pay (link will be texted to you with total amount for you to pay)
Mail medications via USPS ($5 shipping and handling fee, must be paid in full before shipment. We will text you a link where you can make payment)
Address if you want your medication request mailed
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet Name
*
Medication Request
Please list each medication name and the quantity requested.
Medication #1
Medication #2
Medication #3
Medication #4
Food Request
Please is the name of the food and the quantity requested. All food items must be picked up in our office.
Food Request #1
Food Request #2
Anything you need to let our office know about your pet's medications and or food or if you need more room to put in request...
Submit
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