Prescription Refill Request

Please complete the following form if you wish to request a refill for your pet's prescription. Please note that a veterinarian from our office must have prescribed the original prescription.

We will respond to your request within one business day by telephone, email or text message if we have any questions. Your prescription will be ready within 24 hours and we will inform you when it is ready for pick up.

Client Information

First Name:

Last Name:

Email:

Telephone:

Cell phone number (for text messages):

We will text you when your prescription is ready for pick up. If you would prefer to be notified via phone call or email, please indicate your choice below. Telephone Email

Prescription pick up

Where would you prefer to pick up the prescription?: Cascade Hospital for Animals Breton Village Animal Clinic

Request Information

Patient's name

Prescription

Drug 1 Description

Drug 1 Name, Rx # (located on the bottle)

Drug 1 strength/Dosage you are giving

Drug 1 Quantity Requested

Please list any comments or questions regarding this prescription

Prescription 2

Drug 2 Description

Drug 2 Name, Rx # (located on the bottle)

Drug 2 strength/Dosage you are giving

Drug 2 Quantity Requested

Please list any comments or questions regarding this prescription

Please Confirm