Medication Request Form
Please use this form to request flea treatments, worm treatments and other regular medication that is prescribed for your pet. If the medication request is authorised we will send you an invoice by email. Please visit our online payments page to make payment then we will dispatch the medication or make it available for collection. If there are any queries we will contact you by phone to discuss. Please complete the form once for each pet that you require medication for.
What is your surname? *
What is your pet's name? *
Is your pet a member of our Lifetime Care Club? *
What is the first line of your address? *
What is your contact telephone number? *
What is your email address? *
How would you like to recieve this medication? *
What is the name of the medication you would like to request? *
How many of this medication do you require? *
Would you like to request any further medications? *
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