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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.
Phone
This field is for validation purposes and should be left unchanged.