Form Client Prescription Refill Request Form

Client_Prescription_Refill_Request_Form

Medication cannot be prescribed for a patient who has not been examined by one of our neurologists within the past year. Please contact us if your pet's last examination was over one year ago.

The quantity of medication cannot be guaranteed; the doctor may only be able to approve the same or lesser amount than previously prescribed.

Additional restrictions may apply depending on the particular case and we will contact you if we have questions.

Please allow 2 business days for your request to be processed and ready for pickup at the VNC or called into a pharmacy.

In order to ensure you have a backup of your submission, please print and/or email a copy of this form.

To print a copy of this form:

  1. Prior to submission, click the print function from your browser.

To receive a confirmation copy of this form via email:

  1. Enter your email address in the Email Address box
  2. If you do not receive the confirmation copy shortly after submission, please contact us.