Form for requesting a repeat prescription

Practice request is submitted to

This is where your pets medication will be collected from

Name

First Name

Last Name

Email

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred contact number

(###)

###

####

Alternative contact number

(###)

###

####

I am aware of your privacy policy

YES

Pet's name

Pet's breed

Name of medication

Strength of medication (e.g. MG)

Quantity of medication requested

Current dose patient is receiving e.g. one tablet per day

Anything you would like us to know?

Please fill out the form fully to request a repeat prescription. It takes 72 hours for a request submitted here to be processed - if you have an urgent request for medication or require a written prescription please call us.

Ensure you leave an up to date contact number so we can contact you if there is any query regarding your prescription request. We have to see animals under our care regularly in order to prescribe repeat medications (this includes parasite control) so we may need to contact you if your pet is due for a check up.

We may need to contact you if there is a stock issue with your pet’s medication and we need to use an alternative

Our privacy policy can be viewed here

We treat information sent to us sensitively and keep it confidential.

The box on the above form must be checked to show that you are aware of this policy and that you can view the policy at your convenience.