Prescription Refill Request | Smith Veterinary Hospital

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. Please note: we are happy to mail you pets medications to you. If you would like them mailed, just let us know.

A guideline for some of the more common refills and blood test monitoring. A minichem checks liver, kidney, glucose & protein, as well as red & white blood cell counts to make sure there are no ill effects of the medication and that your pet is able to metabolize them correctly.

Drug Name	Labwork	Frequency

Amitriptylline	Minichem 2	Every 6 months
Tapazole	Minichem 2 & T-4 test	Every 6 months
Thyroxine	T-4	Yearly
Phenobarbital	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 or with any other questions or concerns
Credit Card Preauthorization form. Please complete this form and fax (952-882-0798) or bring it in.

Owner Name*
Address*
Street Address Address Line 2 City State ZIP Code
Medication Name Strength Quantity
Email*
Phone Number where you can be reached if there is a problem*
Animal Name*
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...
Please fill in if you checkboxed the third option.
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.

Medication Name	Strength	Quantity