Refill Request Form

FOOD & PRESCRIPTION REFILL REQUEST

Please Note: All online prescription requests made through our website via this form will be ready for pick up no sooner than 24 hours from the time they are requested. If a request is sent over the weekend, it will be received on Monday and ready for pick up on Tuesday. If the home delivery option is selected, we will contact you to make arrangements. When your prescription is ready, we will notify you via the communication method you've chosen below!

Did you know? We have our very own online pharmacy! It offers a range of products we do and do not offer in-house that ship straight to your door! An even bigger plus (for your pet's healthcare): our veterinarians can still keep tabs on all the medications, supplements, and food they are on as if they were picked up from the office (just like your human pharmacist.)

Contact:

* Indicates required field

Owner/ Co-Owner Name *

First

Last

Phone Number *

Email *

Prescription Medications:

Food:

Pet's Name *

List all prescriptions by name and milligram (mg) or dosage. Please refill: *

Dry Food Requested (including weight of bag): *

# of Bags Requested: *

Canned Food Requested: *

# of Cans Requested: *

LOCAL Home Delivery Request: Would you like us to potentially deliver this order to your home? *

Yes

When my pet's prescription is ready for pick up, notify me via: *

Phone Call Text Message Email

Submit

FOOD & PRESCRIPTION REFILL REQUEST

Adair County Animal Hospital & lASER sURGERY cENTER

Pet Owner Resources