Behavior Vets of NYC
Prescription Refill Form
Your First and Last Name
Your Pet's Name
Your pet's last known weight in pounds? (so we can alter dosage based on change in weight if necessary)
Date last weighed?
Medication being requested?
Size/strength of tablet or capsule (mg) or liquid (mg/ml)?
How many pills or mls at one time?
How many times a day?
Quantity needed for one month, i.e., # of tablets or capsules or # of mls for liquids?
If you and your Behavior Vet agree that your pet is stable, would you like us to approve enough medication to last 3 months at a time at your pet's current dose?
Is this medication helping?
Yes, some changes noted
Describe any side effects noted.
List any new medications or supplements prescribed by another vet (to check for drug interactions).
We need at least 3 business days to refill prescriptions. If you need yours sooner, check "yes". If you do not need the refill urgently, check "no". NOTE: There is an additional fee of $40 for Urgent refills.
Yes (By checking this box, I understand there will be a $40 fee payable to Behavior Vets prior to the medication being called in.)
How do you wish to obtain this prescription?
Call into outside pharmacy
Vets First Choice
Name and phone number of the outside PHARMACY if you selected "Call into outside pharmacy"
Click to Submit
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