Repeat Medication Request Form

First name

Last name

Phone

Pet's name

Medication being requested and amount (e.g. number of tablets or box size).

How is your pet? Are they well? Has there been any change in their condition (vomiting, diarrhoea etc)?

What dose are you currently giving and how often is your pet having the medication?

Is your pet on any other medications, new medications or supplements? If yes, please list them here

When would you like to pick up the medication? Please note that requests are reviewed during business hours. 24 hours notice is required to fill any script requests.

Has your pet been seen by our veterinarians in the last 6 months? If not we may not be able to dispense medication without examining your pet. Some medications need to have more frequent visits to dispense depending on the condition

Yes, in the last 6 months

Yes, in the last 6-12 months

No. If not, you will need to see the vet or call us for more information.

If you have registered your pet's insurance details with us, would you like us to process a GAP only claim for you prior to pick up?

Yes

If the veterinarian needs to contact you about your request please indicate your contact preference below

Phone call

Is there anything else our veterinarians need to know about your pets medication?

Please be aware that there are legal requirements we must meet in regards to the dispensing of prescription medication. We can only dispense medication to patients who have been examined by our veterinarians and repeats are at the discretion of the veterinarian.

This form is for long term medications only. We will not repeat short term medications such as antibiotics, ear or eye drops (excluding long term eye medications) on this form.

Please allow 1 business day for your request to be processed. If you need a medication more urgently please call us on 97331356

Call us today to make an appointment
97331356

Waroona Veterinary Clinic

Award winning veterinary care
Supporting your local community since 1969

Repeat Medication Request Form