Prescription Refill Requests — Mountain Animal Hospital

Prescription Refill Form

Please allow at least 3 business days for food and medication refills and at least 7 business days for compounded medication refills (from Summit or Chiron). Please have your current medications on hand as we may verify the medication name, concentration, amount, and directions for use.

We do not fill prescriptions for pets seen at other clinics.

This form is for refills of current ongoing food and medications only.

Your Name

First Name

Last Name

Your Pet's Name

Name of the medication or food to be refilled.

For medications, please copy exactly the name given on the prescription label (eg Metacam 100ml). For foods, please specify the exact diet and size (eg Royal Canin Gastrointestinal Low-Fat 4kg)

For medications only: How much and how often are you currently giving this medication? (eg 1 tablet every 12 hours)

A staff member will contact you to confirm this request before your order is placed. Please leave the best daytime phone number or email to reach you.