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Prescription Request Form
Please allow 48 hours for a prescription request to be processed.
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Client Name
*
First
Last
Phone
*
Email
*
Patient Name
*
Medication Name & Strength (mg)
*
How are you currently dosing?
*
Quantity Requested:
*
Preferred Pharmacy
*
Healthy Paws Animal Hospital
Covetrus online pharmacy for direct ship-to-home
Other
Other
*
**Note:
We are unable to fax to CVS Pharmacy, but can provide a written prescription that can be picked up in the office.
We do not interact directly with any online pharmacies other than Covetrus. Any other online pharmacy will require a written prescription picked up in the office and mailed by the client to the pharmacy.
Email
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