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Three Cute Puppies

Prescription Request Form

This online form is for when a client needs a prescription refilled for their pet and should only be filled out and requested if we have physically seen your pet within the last 6 months. 

Please allow 3 business days to fill your pet’s medications. Medications are filled Monday through Friday 8 am to 5 pm. This means if you submit a request at 8 pm Monday then your prescription will be filled and called into your pharmacy by 5 pm on Thursday. If you request your pet’s medication at 8 pm Friday, it will be called into your pharmacy by 5 pm on Wednesday. Please check with your pharmacy prior to filling out this form on the cost of medication and if it is currently in stock.  

If an urgent prescription request is needed, fill out the form below and pay for the $40 urgent fee on the services tab and email Veterinary Psychiatric and Behavior Center.  Please note that most controlled substances cannot be called into a pharmacy and require a written script that cannot be obtained via urgent prescription request. Urgent prescription request will be called into your preferred pharmacy within 24 hours Monday- Friday only. ​

Has your address changed since your last prescription request or visit with VPBC?
Yes
No

Pet Information

Medications

Please list all medications you are requesting refills for.


Please fill out this section completely and check your current prescription bottle(s) for the correct name and strengths of your medication(s).


Responses such as "on file" are not valid and will result in a delay in prescription refill processing.

Is this medication helping?
Yes, definitely
Yes, some positive changes noted
Not Sure
No
We need at least 3 business days to refill prescriptions. If you need yours sooner, check yes. If you do not need the refill urgently, check no.
Yes
No
How do you wish to obtain this prescription?
Written prescription
Call in to local pharmacy

Controlled Substance Prescriptions cannot legally be mailed or called into pharmacies, so they require you to PICK UP a written prescription. If you selected "Written Prescription," and it is not for a controlled substance, then it will be mailed to you within 3 business days.

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