Request Refill

Name On Account*

First Last

Phone On Account*

Pet's Name (s)*

Have we examined your pet (s) within the last 12 months?*

Yes
No

In order to dispense prescription medications our veterinarians are required by Missouri law to have examined the pet within the previous 12 months. Please contact our office at 816-229-1544 to schedule an appointment. If your pet is out of medication, please mention this when scheduling and we will dispense enough medication to last until the appointment date.

Medication(s) Requested:*

Would you like to pick up at the hospital or have your items mailed to you?*

I will pick it up at the hospital.
Please mail it to me.

Please check to indicate agreement with pick up time.*

I understand that refills requested online will not be ready for pick up until the next business day.

If you must have a refill today, please do not request online. Call the office at 816-229-1544 and ask if we are able to fill it for you today by phone order.

We cannot ship pet foods or items that require refrigeration such as insulin. Visit our main pharmacy page for a link to order Purina diets with free shipping to your home.

Shipping Address*

Street Address Address Line 2 City State ZIP Code

Payment is required prior to shipment. How would you prefer to pay?*

Email or text me a secure link to pay online by credit card.
Call me and I will give you a credit card number over the phone.

How do you prefer to be contacted?*

Email
Text
Phone

Email*

Enter Email Confirm Email

At what number may we text you?*

At what number may we call you?*

Questions or Comments

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