Please note, the echeck-in discount promotion has ended. As a courtesy you may continue to use the form below to request a refill for medications that you have previously received from us. USE ONE FORM PER PRESCRIPTION, AND SUBMIT THE PRESCRIPTION AT LEAST ONE DAY PRIOR TO DESIRED PICK-UP DAY. For prescriptions NOT picked-up here, or for written prescriptions, please contact the office by phone during office hours. Please contact us by phone if you do not hear from us the day after submiting your request.
Your name:
Patient (pet) name:
5 Digit RX number (from rx label)
RX Name
To process your medication,please check all the boxes below.
If you do not agree with the statements, please call our office
to request the refill over the phone.
I obtain this medication from The Family Vet.
I affirm that dosage is directed on the label.
I affirm that the patient named above is stable with the current treatment.
eMail
Phone
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