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24 Hour Emergency & Critical Care
Current Wait Time for ER: Minutes Please call us before coming in to discuss your pet's current condition.
Get in Line for the ER

TEST PAGE REFILLS

Your Full Name*
Your Pet's Name*
Email*
Phone Number*
Has there been any change in your pet's health since they were last seen at VSC?*
- NO
- YES
What has changed about your pet's health since they were last seen at VSC?*
How would you like to submit your refill request?*
- Picture of the prescription label. (fast and easy)
- Completing our refill request form.
Are any of these medications prescribed by our Dermatology Department?*
- No
- Yes
Medication Label Picture(s)

Use the "+" to upload a picture of each prescription label you wish to refill.*

Please make sure the picture cleary shows the medication name.

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Are any medications being given differently than on the label?*
- No
- Yes
Please provide the name of the medication(s) and the current directions that are different from the label(s).*
Does this medication(s) need to be called into an outside pharmacy?*
- No
- Yes
Please list the medication(s) that need to be called into outside pharmacy (write ALL if applicable)*
Please note that any medications not listed below will be filled by our in-house pharmacy and will need to be picked up at our hospital.
External Pharmacy Name*
External Pharmacy Phone*
External Pharmacy Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Medication #1
Name of Medication #1*
For example, Doxycycline.
Concentration/strength of Medication #1*
For example, 25mg.
Current Prescription Instructions for Medication #1*
For example, Give 1.5 tablets by mouth twice daily.
Prescribing Department*
Please choose the department that originally prescribed this medication.
Does Medication #1 need to be called into an outside pharmacy?*
- No
- Yes
External Pharmacy Name*
External Pharmacy Phone*
External Pharmacy Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Any additional medications?*
- YES
- NO
Medication #2
Name of Medication #2*
For example, Doxycycline.
Concentration/strength of Medication #2*
For example, 25mg.
Current Prescription Instructions for Medication #2*
For example, Give 1.5 tablets by mouth twice daily.
Prescribing Department*
Please choose the department that originally prescribed this medication.
Does Medication #2 need to be called into an outside pharmacy?*
- No
- Yes
External Pharmacy Name*
External Pharmacy Phone*
External Pharmacy Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Any additional medications?*
- YES
- NO
Medication #3
Name of Medication #3*
For example, Doxycycline.
Concentration/strength of Medication #3*
For example, 25mg.
Current Prescription Instructions of Medication #3*
For example, Give 1.5 tablets by mouth twice daily.
Prescribing Department*
Please choose the department that originally prescribed this medication.
Does Medication #3 need to be called into an outside pharmacy?*
- No
- Yes
External Pharmacy Name*
External Pharmacy Phone*
External Pharmacy Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you need any of these medications expedited ($25 fee per medication)?*
Expedited medication refills are filled within 48 hours or less and may be limited to a one-week supply if requested outside the original prescribing department's normal business hours.
PLEASE NOTE: Dermatology medications are not eligible for expedited service at this time.
Which medication(s) would you like to have expedited?*
- Select All
- Medication #1
- Medication #2
- Medication #3
Comments
IF CLICKING SUBMIT BUTTON BELOW DOES NOT DISPLAY SUBMISSION SUCCESSFUL, PLEASE SCROLL UP, CORRECT ANY FIELDS HIGHLIGHTED IN RED, AND TRY AGAIN.
Comments
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