Medication Refill Request

Medication Refill Request

Thank you for taking the time to fill out this form. It should take you 2 minutes or less to complete.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Pet's Name
What medication(s) are you wanting refilled?
What dose of medication are you currently giving (for example: 5mg or ½ tab)?
How often are you giving this medication? (for example: once monthly, twice daily, every 8 hours)
How has your pet being doing on this/these medication(s)? Has your pet expereienced any adverse side effects from the medication? If yes, please list out symptoms.
How many days of this medication do you have left? When do you need this medication refilled by? (for example: 5 days left, May 5th 2024)
What quantity of medication do you want refilled (for example: you can write 30 tabs, 60 tabs, 1 month supply, 6-month supply, 90 days supply and so on?
Please Note: Doctors will have to approve large Qty Requests on some medications, There also may be a delay for large quantity request if the quantity requested is not in stock. For example: 300 tabs of Carprofen is a large request. *Heartworm and Flea prevention is the exception and can be filled in 1 year quantities with a current exam without additional Doctor approval*
Please Select, I perfer to:
***Delivery and Shipping Fees Apply***
***State Law Requires YEARLY Examinations be performed and kept up-to-date on each pet before medications can be prescribed***

Once submitted and approved, you will receive an invoice for payment via email. Once paid, please note that many of our medications are stored on our vans so please allow 48 hours for all refills (and a minimum of 72 hours for compounded or specialty meds). Invoices paid after 3pm will be put in for fulfillment the following business day. Thank you for supporting our small business!
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