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| Client Name: | |
| Email: | |
| Phone Number: | |
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| Pet Case Number: | |
| Pet Name: | |
| Pharmacy to Use: | |
| Pharmacy Phone Number?: | |
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| Please select which method you would prefer us to contact you by when your order has been filled: |
| by Phone | |
| by Email | |
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| Patient Update**: |
| Before we fill your prescription, please give us a brief summary as to how your pet is doing while on the current medication. |
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| Comments (ie: pick-up time, quantity desired, mailout, etc): |
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* Please call 612-624-0797 for all questions.
** Please Allow 3 Business Days for Orders to be Called Into Pharmacy. Please phone Your Pharmacy ahead to ensure your order will be ready. |
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