Prescription Refill Request

PRESCRIPTION REFILL REQUEST

Full Name on Account*
First Last
Client birthdate*
Date Format: MM slash DD slash YYYY
Address*
Street Address City State / Province / Region
Phone*
Pet's Name*
Medication*
How much is given*
How often is it given*
When is the medication given?*
How is your pet doing on the medication?*
Do you have any questions or concerns you’d like to discuss with the doctor?*
I would like:*
- Prescription to pick up
- A written prescription
- Prescription faxed to local pharmacy
Pharmacy
Name Street Address City
Picked up in:*
- Ferndale
- Fortuna
- Home delivery (additional shipping cost)
•All requests are reviewed by the prescribing veterinarian and take 24-48 hours to process.
•Written prescriptions are only good for 30 days. You will need to mail it directly to the company you are working with.

We will contact you when the prescription is ready.

Ferndale

Name: Humbolt Veterinary Medical Group
Address: 1140 Van Ness Ave., Ferndale, CA, 95536, US
Telephone: (707) 786-4200
Price range: $$$