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. You can request up to 3 medications on this form.

Please Note: Requests that do not offer the specific details listed below do require a team member to call you to clarify before we can proceed with your request as we do not want to make up the wrong medication. If you do not have the bottle available as it's already been discarded, please call the clinic to request your medication over the phone instead.

Due to COVID-19 we strongly suggest requesting medication refills 1 week in advance as we are working under limited resources and our suppliers are also taking longer than usual to deliver our orders.
Has your pet had a physical exam at YPH within the last 12 months? *
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 a physical exam.
What is your pet's name? *
What is your last name on file? *
What is the best number to reach you at if we have any questions about this request? *
Are you looking for a refill of medication your pet is actively taking? *
What is the name of the medication? *
Please be specific and refer to the medication label on hand for these details. Please note that requests that read "on file" 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? *
This will present as a number followed by "mg" or "mg/ml" after the name of the medication on the label. Example: "2.6mg"
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.
When did your pet receive their last dose? *
Has there been a recent change in your pet's dose? *
How is your pet doing overall? *
How much / how many days worth of the medication do you have left on hand? *
How much / how many days worth of the medication are you looking to have made up? *
Has your pet travelled or do you plan to travel with your pet outside the lower mainland? (If yes, please specify where and when) *
Different regions have different medical and/or parasitic concerns we'd like to prepare you for!
Is there a second medication for the same pet you need to refill? *
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