• 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.
  • MM slash DD slash YYYY
  • Medication Details

  • (Ex: 1/2 tablet twice a day.)
  • (Ex: 30 tablets or 1 month supply etc.)
  • (If not at FVRC, please list the name of the pharmacy, location and phone number.)
  • (If yes, a STAT fee of $10 will be applied to the invoice.)