Medication Request Form

Medication Request Form

Please allow 24-48 hours for requests to be filled. You will receive a phone call when your order is ready.
Do you already have your pet portal access? If you have refills remaining on your pets prescription, CLICK HERE to sign in and order.

All other medication requests may be submitted using the form below. You will be notifed once your pet's precription is ready for pick-up!
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Pets Name
Name of Medication:
Concentration of Medication (eg, 75mg:)
Quantity Desired:
Will you be picking up at Cape Veterinary Hospital or call into pharmacy?
Name of Pharmacy
Pharmacy Phone Number
Please enter a valid phone number.
List any other comments here:
Would you like to have your medication delivered to you for a $7.50 fee?*

YesNo
Should be Empty: