Colonial Heights Veterinary Hospital

Patient Information
Pet's Name*
Species*
Owner's Name*

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Owner's Cell Phone Number*
Please enter a valid cell phone number for text messages from the pharmacy.
Owner's Address*

Street Address

Street Address Line 2

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Postal / Zip Code
Owner's Date of Birth*

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Date

New FDA Guidance Document
Due to new animal compounding documentation requirements from the FDA, please select one of the options below.
Reasons to compound:*

When no other medically appropriate treatment options existWhen a veterinarian, acting within a valid veterinarian-client-patient relationship (VCPR) determines there is no medically appropriate human or animal drug that is FDA-approved, conditionally approved, or indexed to treat the animalIngredient in approved product is toxic to speciesPatient requires dose that would require a fraction of the approved tablet, and tablet is not scored to accomplish fractioned dose

Colonial Heights Veterinarian Clinic