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Repeat prescription request
Repeat prescription request
Please use this form for submitting a repeat medication request or a food order.
If you are human, leave this field blank.
Your details
Pet's name
*
Has your pet been seen by the practice in the last six months?
*
Yes
No
In order for us to be able to issue a repeat prescription, your pet(s) will have had to be seen at one of our branches in the past six months. This is both a legal and necessary requirement to ensure the drug is suitable for your pet. This period can be shorter depending on the advice of the vet.
Owner details
In order to be able to identify you on your system we need to ask you for your details.
Title ▼
Mr.
Mrs.
Ms.
Miss
Dr.
First name or initial
*
Last Name
*
Address
*
Postcode
*
Contact phone
*
In case we need to contact you in regards to this order
Email
*
In case we need to contact you in regards to this order
Terms & Privacy
*
I verify and I am over the age of 18
I agree to have read and accepted your
terms
and
privacy policy
. Your privacy is important to us and you can find out more about how we use your data from our “Full Privacy Notice” which is available from in the links above.
Medication 1 (or food)
Medication 1 (or food)
Please enter the details about the first medication.
Name of 1st medication (or food)
*
Please enter the exact name of the medication
Medication 1: Current Dose on Label
*
Please enter the current dose of medication as written on the label. Enter n/a for food orders.
Medication 1: Dose that you actually give to your pet
If different from the dose on the label please state what dose you are actually using.
Medication 1: Volume requested (or food)
The volume you would like to order. Example: 1 month. Please be aware this might not be the volume you will be prescribed as it could differ from what the vet has advised or if requested volume not available.
Medication 2
Medication 2
Please enter the details about the second medication. Leave blank if no 2nd medication.
Name of 2nd medication
Please enter the exact name of the medication
Medication 2: Current Dose on Label
Please enter the current dose of medication as written on the label.
Medication 2: Dose that you actually give to your pet
If different from the dose on the label please state what dose you are actually using.
Medication 2: Volume requested
The volume you would like to order. Example: 1 month. Please be aware this might not be the volume you will be prescribed as it could differ from what the vet has advised or if requested volume not available.
Medication 3
Medication 3
Please enter the details about the second medication. Leave blank if no 3rd medication.
Name of 3rd medication
Please enter the exact name of the medication
Medication 3: Current Dose on Label
Please enter the current dose of medication as written on the label.
Medication 3: Dose that you actually give to your pet
If different from the dose on the label please state what dose you are actually using.
Medication 3: Volume requested
The volume you would like to order. Example: 1 month. Please be aware this might not be the volume you will be prescribed as it could differ from what the vet has advised or if requested volume not available.
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