Medication Refill Request Form

Please allow up to 3 business days for us to process the refill request. If your pet requires a refill sooner, please use the URGENT Medication Refill Request Form (please note there is an additional fee for urgent requests)

All refill requests must be approved by our team before they will be dispensed.

To request a refill, your pet must have had a recheck with VADER Clinic within the last year. If your pet has not had a recheck within the past 12 months, please call us at 519-821-7546 to schedule an appointment before submitting a refill request.

Your First Name

Your Last Name

Pet's Name

Secondary Last Name (that your pet may be listed under)

Phone

(###)

###

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Name of medication(s) you are requesting to be refilled.

Please include the strength of the medication and how often you are using it.

How many months would you like to renew?

How is your pet current doing on this medication?

What other medications is your pet currently receiving that you are NOT refilling?

Please indicate the dose and frequency.

Where would you like to pick up the medications?

For external prescription requests:

I understand that prescriptions sent to be filled at my family veterinarian or a human pharmacy are subject to a prescription writing fee of $42.09 (including tax).

I understand

Payment of medication is required prior to dispensing (or sending of external prescription) once approved.

I understand

If your refill request is approved, how would you like to pay?

For all payment, methods, a receipt of payment will be emailed to your after payment collection

I authorize you to use my credit card on file.

Please call me to collect payment.