Repeat medication order form

This form is for the use of current clients with pets on long term prescription medication. We are unable to supply drugs for pets which have not been seen by a veterinarian. If your pet is due for a wellness check up, your pet will be required to see a veterinarian before medication can be dispensed. If you wish to see a veterinarian please contact us to make an appointment. You can make an appointment online by using our appointment request form.

Please allow 24 to 48 hours for preparation of medications. You will be contacted when the medications are ready to be collected.

* indicates required field

Your surname: *

Your first name: *

Preferred contact phone number: *

Alternative contact phone number:

Email address:

Which is your preferred method of contact?: *

Phone

Email

Pet's address: *

Pet's name: *

Medication #1

Drug name: *

Current dose (if known):

Amount required:

We will dispense the same amount as per your pet's last prescription unless stated here.

Medication #2

Drug name:

Current dose (if known):

Amount required:

We will dispense the same amount as per your pet's last prescription unless stated here.

Which clinic would you like to pick up from?: * select...Adelaide Animal Hospital (Trinity Gardens)Prospect Road Veterinary HospitalGoodwood Raod Veterinary Clinic (Cumberland Park)Burnside Veterinary Centre

When do you intend to pick up your pet's medication?: *

Please indicate date and time AM/PM.

Has your pet's health or general wellness changed since we last saw him/ her?: *

Yes

No

If no, as a precaution we may need to call you to discuss further.

General comments:

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