Rx Refill

Your Name

First Name Last Name

Your Phone Number

Please enter a valid phone number.

Is this medication refill being paid by a rescue?

Pet's Name (the name CHEW has on file)

Rescue's Name

What Medication are you wanting refilled? -- include mg

Example: Carprofen, 25mg

What are the dosage instructions?

Example: Give twice a day

Are you following the current dosage instructions?

Please explain what you are giving this patient. How often? How much?

How soon do you need this medication?

How many would you like filled?

Any concerns about your pet using this medication?

Has your pet been seen at CHEW in the past 12 months?

Thank you for filling out our Rx form, we will process your refill as soon as possible!

Please read below for some important information:

▪️CHEW Animal Clinic needs your help by supporting our phamarcy.

▪️Why is this important?

🦋 Pharmaceutical companies give us a discount when we purchase larger quantities of medication. By filling your prescription in our pharmacy, we will continue getting medications at a discount

🐝 Although we keep the prices of our medications lower, we do generate a small amount of profit to help keep us running. We simply don't cover our costs with our services and any additional revenue helps us continue our mission.

🐞 CHEW offers a flat shipping fee of $5.00 for Simperica Trio (6-12mth supply)

🐜 CHEW offers a flat shipping fee of $10.00 for all other medications

🪲 If you live in the Dallas area, and you don't want us to ship it, please consider picking up at CHEW!

Will you be picking up this medication?

Please fill out your shipping information

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

CHEW Rx Refill Request