Medication Refill Request
Please complete this form for a prescription refill for your furry friend at Whitehills Animal Hospital.

If you have any questions, please reach out to our friendly staff by giving us a call at (519) 473-1182

Thank you!
Your Name *
Your answer
Phone Number *
Your answer
Your Pet's Name *
Your answer
Medication Name *
Your answer
Medication Strength (if unsure, please write unsure) *
Your answer
How much/many would you like? *
Your answer
How much and how often are you giving your pet this medication? (frequency, time of day, amount, etc.) *
Your answer
How much of the medication do you have remaining? *
Your answer
How is your pet doing? *
Your answer
Is your pet having diarrhea or dark stools? *
Any changes to your pets thirst, urination, or appetite? *
If you answered yes to either of the last two questions, please explain.
Your answer
Any other medications or supplements/products that your pet is taking? If yes, what dose are you giving? If you aren't giving your pet any other medications or supplements, please enter "none". *
Your answer
Any other concerns or notes you want to share with the doctor?
Your answer
Please allow 24 working hours for most prescription requests. If we need to special order your pet's medication, it may take up to 72 hours.
We will send you a notification when your prescription is ready for pick up.
Thank you!!
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