College of Veterinary Medicine

Veterinary Medical Center

Animal Behavior Prescription Refill

CVMVMC2 - image - 700x190 - Pharmacy
The following form should be used by clients of the Behavior Service. If you are looking for the general hospital Prescription Refill form, click here.
   
Client Name:
Email:
Phone Number:
   
Pet Case Number:
Pet Name:
Pharmacy to Use:
Pharmacy Phone Number?:
   
  Rx Name Strength Amount & Frequency Given Daily
Prescription 1
Prescription 2
Prescription 3
       
* To submit more than 3 Prescription Requests, please add them to the Comments field.
       
Please select which method you would prefer us to contact you by when your order has been filled:
by Phone
by Email
 
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.
 
Comments (ie: pick-up time, quantity desired, mailout, etc):

* 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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  • Last modified on July 2, 2013