Request Medication Refill | Florida Veterinary Referral Center

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 Details
Prescribing Doctor*
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.)
Additional Medications/Information
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Medication Details