Name

First Name

Last Name

Cell phone number

Email Address

Preferred method of contact:

Text Messaging

Phone Call

Email

Pet's name

4-5 Digit rx number from The Family Vet prescription label OR the name of the medication if you obtain it from a different pharmacy.

Please note if the dosage you are giving is different than label instruction (even with doctor's approval). If you did NOT obtain the medication directly from us (for example, you got it from an online or compounding pharmacy), include the name and contact information for the pharmacy below for us to process your request.

For clients picking up prescriptions from us, please choose one:

I will pickup this prescription on a Sunday (8 am - 2 pm).

If available, ship the prescription to my address and bill me.

I affirm that the patient named above is stable with the current treatment.

Instructions on how to request a refill of a medication using our online refill request form:

A. Find the prescription label of the medication that you would like to have refilled.

You will need your companion’s prescription label in order to fill out the form.

B. Complete form answering the questions as directed. You will need to affirm that the patient is stable on the current treatment. If you have changed dosages from what the label says (even with doctor’s approval), or if you did not obtain the medication directly from us (for example, it came from an online or compounding pharmacy), please note the pertinent information in the last box provided for us to process your request,

Your completed form should look like this.

C. That’s it! We’ll contact you with the status of the medication as soon as possible. If you have not heard from us within 48 hours of submitting the request, please call the office at 562-281-7387.

To request a refill of a medication, please complete this request form.

(If this is your first time using this form, scroll down for instructions on how to complete.)

Instructions on how to request a refill of a medication using our online refill request form: