Prescription Refill Request
Current specialty patients may request prescription refills online. Lancaster Veterinary Specialties understands that communicating with you about your pet is extremely important. We kindly ask that you allow 1-2 business days to receive a response. We appreciate your patience and understanding. To schedule an appointment, please call us at (717) 864-8109.
Pet's Name
*
Department
*
Please Select
Cardiology
Internal Medicine
Oncology
Ophthalmology
Surgery
Please choose the department associated with the medication refill request.
Medication(s) Requested
Please provide name of medication requested and strength (ex. mg, ml, mcg) listed on your prescription or discharge form. Provide the number of tablets left in your prescription. If you have a liquid medication, please provide an estimate of the quantity remaining (ex. 25% of bottle remaining).
Requested Medication(s) Information
*
Rows
Medication Name
Strength
Dose Frequency
Quantity Remaining
1
2
3
Preferred Pharmacy
*
Provide location details if applicable (ex. CVS - Lemon St, Lancaster)
Pharmacy Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pharmacy Fax Number
Please enter a valid fax number.
Format: (000) 000-0000.
Contact Information
Client Name
*
First Name
Last Name
Client Phone Number:
*
Please provide the best number to reach you if we have any questions about your request.
Format: (000) 000-0000.
Patient Update
Do you have a recheck scheduled with us? If so, when?
*
Appetite
*
Normal
Abnormal
What food is your pet eating?
*
Are they eating 100% of what is offered?
*
100%
75%
50%
25%
not eating
Is there any increased thirst or urination?
*
Yes
No
Are they having any diarrhea?
*
Yes
No
Are they having any vomiting?
*
Yes
No
Are they sneezing and/or having nasal discharge?
*
Yes
No
Are they coughing?
*
Yes
No
Is their energy level normal at home?
*
Yes
No
Medications
Current Medications
Rows
Medication Name
Strength
Dose Frequency
1
2
3
4
5
6
7
8
9
10
Do you have any other questions or concerns?
Please verify that you are human
*
Submit
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