Repeat Prescription Request Form

1 Start 2 Complete

Full name of pet owner *

Email address of pet owner *

Pet's name *

Medication name(s) *

Strength and dosage

(If known)

Quantity requested

Is your pet still taking this medication as prescribed?

Yes

Any concerns or changes in your pet's condition?

Yes

Preferred collection date:

(Must be at least 48 hours from request)

Day

Month

Year

Would you like a written prescription insead?

(Prescription fee will apply)

Yes

Your pet must be registered with the QVSH General Practice and have had a recent health check
Some medications require periodic review before renewal. We will contact you if an appointment is needed
Payment is required at the time of collection

Please confirm that your pet is under the care of QVSH General Practice and has had a recent health check *

Yes

Leave this field blank

Online Payment