Request Medication Refill Once your request has been submitted you will be contacted within 24 hours. (Monday-Friday) If you are submitting this form on a weekend (Sat-Sun) your prescription will not be filled until the following Monday. If you need your refill sooner please call our hospital and we will be happy to assist you. Note: Florida Pharmacy Law requires that all pets have a current doctor patient relationship. Please feel free to contact us with questions.Date* MM slash DD slash YYYY Pet's Name* Name* Owners' First Name Owners' Last Name The best number for us to contact you*Retype contact number*Email* Medication DetailsPrescribing Doctor*Dr. Cheryl AnkenbrandtDr. Leonardo BaezDr. Hayley BoothDr. Laura BreunigDr. Ashley CaroDr. Jessica GiemDr. Virginia GlanderDr. David HerringDr. Amy LangDr. Ethan MosleyDr. Joshua ParraDr. Jessica SarmientoOther (please specify)Prescribing Doctor (If "other" is selected) Name of Medication* Concentration (Strength)* Dose* (Ex: 1/2 tablet twice a day.)Quantity Requested* (Ex: 30 tablets or 1 month supply etc.)Where would you like to pick up this medication?* (If not at FVRC, please list the name of the pharmacy, location and phone number.)Need a refill within 48 hrs?* (If yes, a STAT fee of $10 will be applied to the invoice.)Additional Medications/InformationCAPTCHA