(919) 467-6146         Fax (919) 319-0197        1130 SW Maynard Road, Cary, NC 27513



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Prescription Refill Request

Please complete this form to request a prescription refill. Please be as complete and accurate as possible.

Your First Name
Your Last Name
Address
City
Zip Code
Phone Number
Phone Number 2
Email Address
Your Pet's Name
Species (dog, cat, etc.) Please give us the details of your requested prescription refill:
Medication name:
Dosage per tablet/capsule/mL:
Quantity:
Amount given for each dose (1/2 tablet, 2 capsules, etc.):
Frequency of dosing:

Additional information:

Thank you! Please note that all refills must be first approved by a doctor. Please allow 1 full business day for your medication to be ready for pick-up. We will attempt to reach you by phone if we have any questions concerning your request.