The Vet's Animal Hospital Rx Request
PLEASE NOTE: THIS SERVICE IS ONLY FOR CLIENTS OF THE VET'S ANIMAL HOSPITAL.
Name of Medication
Dosage (mg., etc.)
No. of Tablets/Capsules, etc.
Is this a refill?
Comments or questions for the Veterinarian
Charge to which credit card?
Credit Card No.
CCV (Security No.)
Name on Card
Billing Address (if different from above)
The amount to be charged to your credit card will be sent to you by e-mail
at the time the prescription is authorized by the Veterinarian.
Please click on "SUBMIT" below to send your order.