Prescription and Food Order Request Form

Use the form below to request your prescription refill or food item.

Please allow 72 hours for order processing. If you need your request sooner, please call our clinic directly at 734-436-0455. You will receive a text message once your request is ready to pick up.

IMPORTANT: Some requests will require an examination of your pet prior to re-filling. This ensures that the medication or food is appropriate for your pet’s current condition. If this is the case, one of our staff members will reach out to you to set up an appointment.

Name

First

Last

or Medication Quantity

Phone Number

Pet's Name

Medication or Food #1

Name of Product

Dosage/Size/Strength

Quantity

Medication or Food #2

Name of Product

Dosage/Size/Strength

Quantity

Medication or Food #3

Name of Product

Dosage/Size/Strength

Quantity

Medication or Food #4

Name of Product

Dosage/Size/Strength

Quantity

Additional Comments

Prescription and Food Order Request Form

Medication or Food #1

Medication or Food #2

Medication or Food #3

Medication or Food #4

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