Prescription Refill Request

Your Name*

First NameLast Name

Pet's Name*

Please note the following:

1. Medications can only be refilled with a current exam and may take up to 72 business hours for approval. A rush fee will be applied if the medication is needed sooner.

2. Special order medications may take up to a week to arrive and are subject to availability so please request refills well in advance.

3. For heartworm prevention, if your pet has missed more than 2 doses (more than 60 days without prevention) but not more than 6 doses (6 months) you may restart prevention without testing. If your pet has missed more than 6 months of preventative a heartworm test is required prior to restarting to ensure they are not positive. In addition to their annual testing, If there has been a gap in treatment of more than 60 days we recommend performing a heartworm test 6 months after restarting to ensure your dog is not positive.

4. If your pet is due for an exam and lab work, and the medication is a chronic medication, we may fill a limited quantity until the exam and lab work is updated. Please note that lab work for chronic medications may be required every 3 months to every 12 months though interval is up to DVM discretion and the specific disease process being managed.

5. Please note that we do not work directly with online pharmacies and some, like Chewy, are now requiring hard copies of the written prescriptions mailed to them directly. We will provide written prescriptions for you to pick up and are not able to fax/email/authorize through online pharmacies otherwise.

6. If you are requesting a refill of a medication called into a local human pharmacy (such as Safeway or CVS), please contact the pharmacy to send us a refill request. Our Fax number is 1.888.648.7511

7. If you are requesting a new medication to be sent to a pharmacy, we will either prepare a written prescription for you to pick up and take to a pharmacy of your choosing or we will fax your prescription to the requested pharmacy. We will not call in prescriptions to pharmacies due to prolonged hold times.

Configurable list*

Medication Name and Strength (mg or mg/mL):*

Ex: Prednisolone 5 mg/mL

Quantity Requested: *

Ex: 3 month supply; 60 tablets, etc

Dose and Frequency of Administration: *

Ex. 1 tablet every 12 hours

For heartworm preventatives Simparica Trio, Trifexis, Interceptor, etc.): Has your dog missed more than 2 consecutive months of prevention?*

NoYesNot Applicable

How is the patient doing on this medication? Any concerns? *

Please be specific

Which pharmacy:*

Pearl Animal HospitalWritten PrescriptionVetSource (Our Online Pharmacy)Faxed to the pharmacy specified below

If this is a chronic medication, how much would you like us to fill (if able).

Fill quantity is subject to DVM approval.

If you selected "faxed to the pharmacy specified below" please provide pharmacy name and location: *

Please provide a location to ensure we fax to the correct pharmacy

A staff member will be in touch if there are any follow up questions. Please remember that it can take up to 72 business hours to process your refill request.

Once the medication is filled we will contact you to let you know the medication is ready to pick up.

If the medication or written prescription is not picked up within 2 weeks of the filled date, it will be returned to stock and will need to be re-requested.