Pharmacy Refill Request
Please allow 24 hours to process your request. We will contact you at the phone number provided if we are unable to process your request. Refills can not be completed for patients without an examination on record in the past 12 months. Prices are subject to change without notice. Please complete one form per pet.
Refills may be picked up during business hours, Monday through Friday. Deliveries are shipped next business day via UPS Ground, unless otherwise specified. We will contact you to arrangement payment for delivery.
Client Name (as it appears in the medical record)
*
First Name
Last Name
Pet's Name (as it appears in the medical record)
*
Phone Number
Please enter a valid phone number.
Email
example@example.com
Medications/Supplements to refill:
Pickup or Ship?
*
Please Select
I will pickup in Wilmette - 405 Linden Ave.
I will pickup in Chicago - 1767 W. Wilson Ave.
Ship to me!
Pickup Date (allow 24 hours for fulfillment)
-
Month
-
Day
Year
Date
Address *required for delivery
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Notification preference:
Please Select
Call
Text
Email
Submit
Should be Empty: