Medication Request Form

If you need a refill of your pet’s medication, you can submit a request for a refill using our online form below! Make sure all required fields in the form are completed before submitting, and allow our team 1-2 business days to complete your request. If you have any questions, call us at (215) 995-4049!

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Medication requests can take 48-72 hours for approval. Please provide an adequate amount of time for us to have your order processed.

By providing this information, you agree to receive information regarding your order via text or email.

ORDER INFORMATION:

How would you like to receive your medication?

Ship to home (additional fees may apply)

Pick up at clinic

Name

First

Last

Please use the name registered on your account

Pet's Name

Cell Phone

Email Address

MEDICATION INFORMATION:
Please complete the information below:

Medication

Medication Name

Concentration (Example: 100mg/ml)

Dosing Instructions (What volume and how many times a day are you administering this medication?)

How urgently do you need this refilled? (Medications can take 48-72 hours for approval)

Add another medication Remove a medication

After your medication is approved an invoice will be sent for payment and we will contact you with information regarding your medication delivery/pick up options.

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