Prescription Request Form

Please complete the form below to request a repeat prescription. Our team will review your request and contact you if any further information is required.

Date of Request *

Owner Details

Owner Name *

Phone Number *

Address *

Email Address *

Preferred Contact Method Phone Email

Pet Details

Sex Male Female Neutered Spayed

Medication Requested

Prescription Type

Collect medication from veterinary practice Written Prescription (collection from practice only)

Under guidance from the Royal College of Veterinary Surgeons, vets must ensure a pet is “under their care” before issuing prescriptions. Repeat prescriptions may require periodic health checks before issuing.

Declaration

I confirm that this medication has previously been prescribed for my pet and that the information provided above is accurate. I understand that the veterinary surgeon may require a health check before issuing a repeat prescription.