Prescription Refill Request
** Please allow 48 business hours for all prescription refills except for allergen/immunotherapy or compounded medications. See below. ** Please allow 1 week minimum (7 calendar days); 2 weeks notice is preferred, for any allergen/immunotherapy or compounded medication refills. We require prepayment for all allergen/immunotherapy and compounded medications as these are made specifically for your pet. An assistant will contact you for this payment once this request is received. *indicates required fields (**This form may take up to 20 minutes to complete.**)
Your Name
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First Name
Last Name
Pet's Name*
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Date Requested
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-
Month
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Day
Year
Date
Email*
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Phone Number
*
Please enter a valid phone number.
Best Time To Call*
*
Alternate Phone Number
Please enter a valid phone number.
Receiving the Meds*
*
Please Select
I Will Pick Them Up
Can we text you updates?
*
Yes
No
Requested Prescription Refills
Please list the names, dosages and quantities of the medication(s) you are requesting.
List the name of prescriptions
*
Your Pet's Current Medications
Please list the names and amounts of any medication your pet is currently receiving. Also include the time your pet last received each medication.
List the name of prescriptions
*
Comments
Please list the names and amounts of any medication your pet is currently receiving. Also include the time your pet last received each medication.
If you have noticed any changes in your pet’s health or behavior, please comment in the box.
Please include a brief update on how your pet is doing.
Submit
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