Prescription refill request

First Name*
Last Name*
Pet's Name:
Home Phone*
E-Mail
How would you like to receive your prescription?	Pick-up Priority Mail
Shipping Fee For your convenience we can mail your item(s) to you. Packages take 3 - 4 business days to receive and are sent Priority Mail. 0-2 lbs | $7.50; 2+ - 5lbs | $12.00; 5+ - 10 lbs | $15.00 For expedited shipments, oversized packages, insurance or delivery confirmation additional fees will apply. We'll call you if your shipping charges vary from our listed rate. We are unable to ship packages over 10lbs.
Please Choose Your Veterinarian:	Dr. Taylor Lyne Dr. Beecher Watson Dr. Valerie Johnson Dr. Kelli Broz Dr. Dee Miller Other
If you need this refill immediately, please call in your request at the hospital where your pet was seen: Chester Animal Clinic (804) 748-2244 Courthouse Road Animal Hospital (804) 745-2323
Prescription Request
Medication Requested	Dosage Size / Strength	Quantity Requested
Name
Name
Name
Name
Phone number we can reach you if we have any questions
Which clinic originally filled your prescription?
Chester Animal Clinic Courthouse Rd Animal Hospital
Comments (Any request for prescription foods, shampoos, flea, tick & heartworm prevention can be entered here)
If we need to call your prescription into a pharmacy, which pharmacy is convenient to you?
Pharmacy Phone
*Required Fields

*On-line refill requests are processed Monday through Friday. Requests received on the weekend will be processed the following Monday.

*Requests will be checked twice daily at 10am and 3pm. If we receive your request after 3pm it will not be processed until the following office day.

The refill form is for the convenience of our clients that have previously been given a medication by one of our veterinarians. The prescribing veterinarian will review the request, and you will be contacted if it cannot be filled. An e-mail confirmation will be sent for filled requests.

Federal and State laws, as well as good medical practice, prohibit us from dispensing prescription medications without prior examination of your animal (within the last 6 months), and current knowledge of your animal's health.

We are similarly prohibited from dispensing or refilling medications that were originally ordered by another veterinarian from a different practice. We will be happy to dispense any needed medications after examining your pet.