*DUE TO LIMITED STAFFING DURING THE PANDEMIC, PLEASE ALLOW AT LEAST 36 HOURS FOR REFILLS.

*All pets must have been examined by one of our veterinarians within the last year for medication refills.
*In accordance with Washington state law, all pets must have an up-to-date Rabies vaccination.
*We are no longer calling or faxing medication requests into Costco, AlliVet or ValleyVet Pharmacies.

Owner's First Name *

Owner's Last Name

Home Phone*

Work Phone

Cell Phone

Your Email *

Notes to the Doctor

PET INFORMATION

Pet's Name *

REFILL INFORMATION

Name of Drug

Drug Strength

Quantity of Drug

---Same as PreviousOther

Quantity of Drug

Current Dosage Being Given *

Refill Notes

Would You Like Your Pets Prescription Called Into Your Local Pharmacy?

---YesNo

PHARMACY INFORMATION

Pharmacy Name

Pharmacy Location

Pharmacy Phone