Specialty Refill Request Form
PETS Referral Center
Please try to request a refill 5-7 business days prior to running out of the medication as it may take up to 2-3 business days to process the request. Refill requests can be made by filling out this refill request form or calling PETS (510-548-6684). Please keep in mind that specialty refills are only processed during working business hours Mon-Fri 8a-5pm.
Client name
First Name
Last Name
Preferred Phone Number
Please enter a valid phone number.
Pet's Name
Which department originally filled the medication?
Ophthalmology
Oncology
Exotics
Surgery
Where would you like this medication refilled?
At PETS Referral Center
Human pharmacy (e.g. Walgreens, Costco, Target, etc.)
Compounding pharmacy (e.g. Wedgewood, Stokes, Mixlab, etc.)
Online pharmacy
If an outside pharmacy was chosen please list the name of the pharmacy and the phone number:
Please provide the name, strength and formulation of each medication:
(EXAMPLE: Prednisone 5mg tablets)
Submit
Should be Empty: