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Prescription

If you are a client at Bristol County Veterinary Hospital and you would like to refill your pet's prescription, please fill out this order form. Required fields are marked with a “*”.

After receiving your order form, a staff member will contact you regarding your prescription. Your prescription will be available for pickup at the front reception desk.

Thank you.

Client ID:
* Your First Name:
* Your Last Name:
* Pet's Name:
* Date Requested: 
* Phone:      
(please include area code)
Best Time To Call:
* Email:    

PRESCRIPTION REQUEST
Medication Requested Dosage Size / Strength Quantity Requested
* Drug: 
  Drug: 
  Drug: 
  Drug: 

 

* Phone number we can reach you at if we
have a problem filling your prescription:  
(please include area code)


PROGRESS REPORT

Time of your pet's last dose:     
Amount given:                         

Has your pet had any:

Behavioral changes?   Yes No     Describe:
Vomiting or diarrhea? Yes No   Describe:
Constipation:    Yes No    Describe:
Changes in urination? Yes No Describe:
Sneezing? Yes No    Describe:
Coughing?    Yes No Describe:
Stiffness/lameness?   Yes No Describe:
Other:   Yes No  Describe:

COMMENTS


Allow 48 hours for perscription refill request to be processed.

If your pet is due for bloodwork your request may be denied. Wellness bloodwork is important to measure levels of medication in your pets blood. Please call the hospital to schedule an appointment. Routine bloodwork may also be required to monitor your pet's organ function during the course of therapy.

* The refill form is for the convenience of our clients that have previously been given a medication by one of our veterinarians. The prescribing veterinarian will review the request, and you will be contacted if it cannot be filled for some reason. An e-mail confirmation will be sent within 48 hours for filled requests.

Federal and State laws as well as good medical practice prohibit us from dispensing prescription medications without prior examination of your animal, and current knowledge of your animals health


    

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