Your first name and last name or business name
*
Email
example@example.com
Phone number on your account
*
Please enter a valid phone number.
Name of animal
*
Type of request:
*
Please Select
Prescription Refill
Food/Retail Item Order
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Prescription Refill
Name of medication
*
If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.
What is the concentration of this medication?
*
This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.
Quantity of this medication requested
*
How often is your animal getting this medication?
*
How much of this medication is your animal getting per dose?
*
How's your pet doing on the current dosage?
*
Add a second prescription refill?
*
Yes
No
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Second Refill
Name of medication
*
If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.
What is the concentration of this medication?
*
This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.
Quantity of this medication requested
*
How often is your animal getting this medication?
*
How much of this medication is your animal getting per dose?
*
How's your pet doing on the current dosage?
*
Add a third prescription refill?
*
Yes
No
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Next
Third Refill
Name of medication
*
If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.
What is the concentration of this medication?
*
This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.
Quantity of this medication requested
*
How often is your animal getting this medication?
*
How much of this medication is your animal getting per dose?
*
How's your pet doing on the current dosage?
*
Add a fourth prescription refill?
*
Yes
No
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Next
Fourth Refill
Quantity of this medication requested
*
How often is your animal getting this medication?
*
How much of this medication is your animal getting per dose?
*
How's your pet doing on the current dosage?
*
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Next
Food/Supplement/Retail Item Order
Name of food/supplement/retail item
*
If you are unsure how to spell it, please spell how it sounds or include a photo of your current food, supplement or retail item below and indicate here that you have. Please include the brand and name of products whenever possible. If this is a food item, please include type (ie. pate, stew, kibble, etc) and flavour.
Size of food, supplement or retail item
*
For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1
Add a second item?
*
Yes
No
Should be Empty: