123 West Harrison  /  Guthrie, Oklahoma  73044  / 405.282.8796 / Fax: 405.282.8798
PRESCRIPTION
REFILLS
PRESCRIPTION REFILL ON-LINE FORM
YOUR NAME:
First                                                             Last
NAME OF PET:
MEDICATION
REQUESTED:
YOUR ADDRESS:
Street Address                                              
City                                                            State        Zip Code
YOUR E-MAIL:
DAYTIME PHONE:
 CELL:
ADDITIONAL
INFORMATION:
In order to provide ease and convenience you may
request a refill for your pet's prescription by submitting
this form. Please fill in all the requested information.
Your request must be approved by a doctor.

You will be notified by e-mail or phone when your pet's
prescription has been approved and is ready to be
picked up. We will also inform you of the total cost of
the prescription, and will ask for your credit card
information by phone at that time. If you would prefer to
have the prescription mailed to you please include your
request in the additional information area on the form.