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Forms: Prescription Refill Request

Drug Information

Our goal is to provide you a simple method for re-ordering your prescriptions with us.
Please check to be sure your pet is current with these guidelines prior to placing your order.

Rx Refill Information Chart
Drug Name Labwork Frequency
Amitriptylline Minichem 2 Every 6 months
Tapazole Minichem 2 & T-4 test Every 6 months
Thyrosin T-4 Yearly
Phenobarbitol Phenobarb Levels & Minichem Yearly
Rimadyl Minichem 2 Every 6 months
Deramaxx Minichem 2 Every 6 months
Prednisone Minichem 2 Every 6 months
Metacam Minichem 2 Every 6 months
Enacard/Enalapril Minichem 2 Every 6 months
Proin Minichem 2 Every 6 months
Cystolamine Minichem 2 Every 6 months
Lysodren ACTH Stim test Every year
Potassium Bromide KBr Level At 120 days & yearly

Most medications not listed will require a physical examination within 1 year.
Please call if you are not sure what requirements are needed for your pet

Credit Card Preauthorization form. Please complete this form and fax (952-882-0798) or bring it in.

 

Owner Name:
Address:
City:
State:
Zip:
Email:
Phone Number where you can be reached if there is a problem:
Animal Name:
Medication Requested:
  Check all boxes that apply to your request:
Please mail the above items to my address*
I wish to be informed of the charges prior to charging my credit card**
Please keep the above prescriptions at the clinic,
I will be in to pick up on...
  This form is offered only to clients whose pets have
1. Been seen at Smith Veterinary Hospital within the last year
2. Have already obtained a prescription for the product requested
3. Have had blood work checked according to the Rx Refill Information Chart
4. Have placed a credit card on file with Smith Veterinary Hospital
(if order is to be shipped out)
* Shipping and Handling charges will apply to all orders mailed out.
All items will be mailed out USPS unless otherwise noted or requested by the client.
** This box must be checked to receive the total amount prior to shipment.
 


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