Prescription Request

Prescription Refill Request:

In our ongoing effort to make your pet's health care as convenient and easy as possible you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

Once your request has been submitted you will receive a notification confirming your request. Doctors reserve the right to decline a prescription refill request based on need for testing, examination, etc. You will receive a phone call if your request cannot be fulfilled.

If you would prefer to have the prescription mailed to you, please check the appropriate box. Payment is required prior to shipment, and our receptionists will call you for payment details at the phone number provided.

For your convenience, prepayment for medication pickup is also available. One of our receptionists will call you for payment details at the phone number provided .

Form - Prescription Refills Online

Name (required)
First Name (required)	Last Name (required)

Address (required)
Street Address (required)


City (required)	State/Province (required)	Zip/Postal Code (required)
,

E-Mail Address (required) :

Daytime Phone (required)
Phone Type	Phone Number (required)

Evening Phone
Phone Type	Phone Number

Pet's Name (required)

Have we seen your pet within the last year? (required)
(Exam within 1 year required by law)
Yes
No

Medication Requested (required)

Current Dosage (required)

Pick up or Delivery (required)
(Shipping Fee of $1.70)
Pickup
Delivery

Requested Date of Pickup (24 hours needed)

Prepay? (required)
(If yes you will receive a phone call)
Yes
No

The verification code below ensures the form is not submitted by a computer

Verification Code :

Enter the code you see in the graphic below in this box.
Your post will not be allowed if you do not type this in correctly.