Prescription Refill Request – PICK UP AT CLINIC

Here’s our plan for how this works: Please submit the information in the form below. We will review, verify, and then process the prescription. When the prescription is ready for pickup, we will send a text .

* Controlled Substances. Please be advised that due to federal and state regulations, extra time will be required at the time of pickup. Please provide a picture ID.

Note: This form is for pickup at the clinic or special orders. For best pricing, you may want to try the online store instead.

Want it delivered?

Online Pharmacy

Owner's Name(required)

Pickup Person(required)

Mobile Number for Text Notification(required)

Medication(required)

Form (example: caplet, tablet, chew, transdermal gel, paste, etc)(required)

Strength (example: 25mg or 100mg or "same as last time")(required)

Amount (example: 60ct or 100ct bottle or "same as last time")(required)

Pet Name(required)

Species(required) Equine

Canine

Feline

Other

Current Usage (How much & how often or "New")(required)

Pet #2 (if you are sharing the package)

Pet #2 Usage (How much & how often or "New")

Payment(required) I will pay at pickup

Charge my card on file

I have multiple cards on file, please use the one ending in these four digits:

Any other questions or comments related to the requested medication?

Prescription Refill Request – PICK UP AT CLINIC

Prescription Refill Request – PICK UP AT CLINIC

Want it delivered?

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