Prescription Refill Form

If you need a refill for a prescription, please note that it may take at least 72 hours for our office to process your refill request. If you are completely out of the medication and need an emergency refill authorized, there will be an emergency refill fee applied as discussed at the consultation.

Refill requests will be processed Monday through Friday during our normal office hours.

Please note: THIS FORM IS NOT NECESSARY FOR REFILLS THROUGH OUR ON-LINE PHARMACY. PLEASE GO DIRECTLY TO THE ON-LINE PHARMACY FOR THOSE REQUESTS https://veterinarybehaviorsolutions.securevetsource.com/index.pml.

****Remember - we cannot authorize a prescription refill if your pet has not been seen by the doctor in the last six months.****

If you are unsure of when your pet was last seen, please contact our office at 877.203.5973 or staff@vetbehaviorsolutions.com.

Owner Name*

First NameLast Name

Patient Name *

Your Email*

example@example.com

Your Phone Number*

Area CodePhone Number

Name of Medication (for example, Fluoxetine)?*

Dosage of Medication (for example 50 mg tablets)?*

How often are you giving the medication (for example every 8 hours)?*

Do you prefer*

30 day supply90 day supply (if an option)Other

Please list any new medications prescribed by your family veterinarian since we last saw your pet?*

Please list any supplements you are currently giving that have not been prescribed/recommended by our office:*

Please give the name of the pharmacy you would like to use:*

Please give the phone number of the pharmacy you would like to use:*

Area CodePhone Number