Prescription Refill and Food Order Request Form

Please use the form below to request your prescription refill or food item. This will save you time when picking up your order. Please allow 24 hours for order processing. Do not come to the clinic until you have received confirmation to pick up your order.

Note: Some prescriptions will require an examination of your pet prior to re-filling.

Many prescriptions require your pet to be examined before dispensing. This ensures that your pet is healthy enough to handle the potential side effects of some prescriptions and provides further confirmation that the medication is appropriate for your pet’s current condition.

IMPORTANT: Prescription Refills and Food Orders are not confirmed until you have received notification. A staff member will contact you by phone or email.

Name*
First Last
Email*
Phone*
Pet Name*
Drug or Food Name*
Dosage/Size/Strength*
Quantity*
Additional Comments*

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We are happy to book an appointment for you. This is not an automatic process. Once we receive your request, we will contact you to confirm a date and time that is as close to your request as possible.

This form should only be used for requesting appointments that will take place at least 2 full business days after the time of the submission of this form.

If your appointment has not been confirmed within 24 hours, please feel free to contact the practice by phone to confirm.

Name*
First Last
Email*
Phone*
Pet Name*
Preferred Date*
MM
DD
YYYY
Preferred Time*

: HH

MM
Reason for appointment*

Prescription Refill and Food Order Request Form

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