Prescription Refill Request

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.

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?

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