Medication Refill Request — Capitol Hill Animal Hospital

Medication Refill Request Form

Please refer to the label on your pet's medication to fill out the essential details requested on this form to ensure all the accuracy of the information being provided.

We request 3 days' notice for prescription refills and 7 days’ notice for all compounded medications requests.

IMPORTANT: Prescription Refills are not confirmed until you have received notification from a staff member, who will contact you by phone or email. Please do not come to the clinic until you have received confirmation to pick up your order.

It is required that pets have been examined within 1 year (or 6 months in some cases) in order for a vet to fill any prescriptions. This ensures the safety and monitoring of your pet's health while taking these medications. Over the counter products do not require an annual physical exam.

What is your pet's name?

What is your last name on file?

What is the best number/email to reach you at if we have any questions about this request?

What is the name of the medication? (example: meloxicam)

Please be specific and refer to the medication label on hand for these details. Please note that requests that read "ongoing" or "same as last time", do not qualify and a team member will be required to call you to clarify before we can proceed with your request as we do not want to make up the wrong medication.

What is the strength/concentration of the medication ? (example 1.5mg/mL)

This will present as a number followed by "mg" or "mg/ml" after the name of the medication on the label.

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

Examples: 1.5 mls twice a day. OR: 1/2 tablet three times a day.

Has there been a recent change in your pet's dose?

How much / how many days worth of the medication are you looking to have made up?

Example - 10mL

Additional comments

How is your pet doing overall? Have you seen an improvement on the medication?

Medication Refill Request Form

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