Request a Refill form

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. The prescription refill must be approved by a doctor.

We will notify you via email or phone when your pet's prescription is approved and ready to be picked up at Sugar River Animal Hospital. We will also inform you of the total cost of the prescription, and will request a credit card number by phone at that time. If you would prefer to have the prescription mailed to you, please mention this information in the additional information area.

PRESCRIPTION REFILLS ONLINE

NAME (REQUIRED)

First Name

Last Name

ADDRESS (REQUIRED)

Street Address

City

State / Province

Zip / Postal Code

DAYTIME PHONE (REQUIRED)

Phone Type

Phone Number

EVENING PHONE (REQUIRED)

Phone Type

Phone Number

OTHER INFORMATION

Pet's Name

Sex

Male

Female

Age: Years, Months

Have we seen your pet within the last year?

Yes

Medication Requested

Additional Comments / Questions

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