Repeat Medication Request

This form can be used to order a repeat script for your pet. It is only available to patients that have been prescribed a medication that they will need to be on long term and have had a consultation with one of our veterinarians within the past 6 months.

Owners Name

Please enter owners name as we have it on file.

First Name

Last Name

Pets Name

Please enter your pets name as we have it on file.

Phone

(###)

###

####

Email

Name of the Medication

Please add the name as it appears on the label including the strength (Example 5mg) and frequency (Example once daily). If your pet requires multiple medications please Include them here.

Has this pet had a consultation with one of our veterinarians in the past 6 months?

All patients prescribed repeat medication require a consultation with one of our vets every 6 months.

Yes

No - Please call the clinic to make an appointment

Is this medication still effective for the symptoms it was prescribed for?

If you feel that this medication is no longer effective OR less effective please let us know. We may have an alternative or we may need to change dose rates.

Yes

No

I'm not sure. Please call me to discuss.

Have there been any changes to the dose since the medication was last dispensed?

Yes - please provide details below

No

If you answer YES to this question please provide details of the current dose and frequency.

Message

Repeat Medication Request

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