Prescription Refill Request

Thank you for considering House Call Vet RVA for your pet’s needs.

Prescription Refill Request Form

Please fill out our prescription refill request form in its entirety to ensure we can provide you and your pet with the best possible care. Please note: Any fields with * are required.

Prescription Refill Request: medication, prescription diets, supplement or herbal supplements*

- Please note allow 48-72 hours for the doctor to review your pet's medical records. We will contact you once the request has been authorized or declined. - If you choose to order from an online pharmacy, please note, in accordance with best practices and national guidelines, we will mail a written script to your home. address. From there you are able to submit the prescription authorization to the pharmacy of your choosing.
Your Full Name*
Phone Number*
Email*
Pet's Name*
Name of Medication, Food, Herbal or Supplement Requested*
Quantity*
I would like my pet's medication refilled by*
Please note, this will ONLY APPLY to medications that cannot be abruptly stopped. This typically can is a result from "last minute" requests leading to your pet's script arriving not arriving in the timeframe required for their medication to arrive. Medications in which abrupt stopping is not critical, please see the below policy for outside online pharmacies.*
I understand an addition fee will applied to my account for any calls for emails with outside online pharmacies to refill my pet's medication(s)
Please note, this will ONLY APPLY to medications that cannot be abruptly stopped. This typically can is a result from "last minute" requests leading to your pet's script arriving not arriving in the timeframe required for their medication to arrive.

Medications in which abrupt stopping is not critical, please see the below policy for outside online pharmacies.
File
You can upload a picture of your current prescription or product to make sure you get the correct item.
Drop files here or

Max. file size: 256 MB.

Prescription Refill Request

Prescription Refill Request Form

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