Please note:

Some refills may require a visit prior to filling. If there has been a change to your pet’s medical status or your pet has not been seen in over 6 months, you may be required to set up an appointment prior to a prescription refill.
VSES has a 24-hour policy on all medication refills. If your prescription needs to be picked up on the same day, an additional $10 processing fee will apply.

Name *

First

Last

Phone *

Email *

PET INFORMATION

Pet's Name *

Prescription requested (Example: Prednisolone 5 mg) *

Dosage listed on prescription package (Example: 1 tablet given by mouth twice daily) *

How are you currently giving this medication? (Example: 1 whole tablet given in the morning, half tablet given at night) *

Doctor

How would you like to receive your prescription? *

Pick up medication
Pick up written prescription
Call prescription into a Pharmacy
Mail medication to my home
Mail written prescription to my home
Deliver to MVA general practice veterinarian

Please note: A Customer Service Representative will contact you, requesting payment, prior to mailing/shipping. Shipping is an additional $10. Some prescriptions are unable to be mailed due to controlled substance laws.

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Desired pick up date and time *

Date

Time

The date must be one business day after the request has been made. Thank you!

Please State Which MVA Practice *

Pharmacy Name *

Pharmacy Address

Address Line 1

Address Line 2

City

State

Zip Code

Pharmacy's Phone *

Please provide us with a brief update on your pet. Any vomiting or diarrhea? Coughing or sneezing? How would you describe his/her appetite and drinking? Is his or her energy level normal currently? If anything is abnormal, increased, and/or decreased, please explain. *

Medication Refill Form

Medication Refill Form

Contact

Hours

Location

Continuing Education