URGENT Medication Refill Request Form

Please note that urgent refill requests incur an additional fee of $54 (including tax). Only use this form if you need your medication refilled within 1 business day.

All refill requests must be reviewed and approved by our team before they can be dispensed.

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

Urgent medication refill requests have an additional fee of $56.00 (after tax)

I understand

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.