First Name
Last Name
Pet's Name
Home Phone
Other Phone
Email
Name of medication
Strength
mg
ml
Format
Quantity Requested
*Note:  If you are experiencing difficulties submitting this form, please email your request to jfebel@svh.ca Be sure to include your pet's first and last name; the medication required as well as the current strength and dose.
 
NOTE: All prescription refill requests must be approved by one of our veterinarians.  Once the request has been approved and the medication has been prepared, we will call you to arrange for a pick-up.