Rhinebeck Equine In-House Pharmacy Refills
For requesting refills of your prescription to be picked up at our hospital.
Email address *
Name of person making request: *
Your answer
Client First Name *
Your answer
Client Last Name *
Your answer
Farm Name *
Your answer
Phone Number - In case we have questions about your order. *
Your answer
Horse's Name *
Your answer
Dr. Prescribing Medication: *
Medication Name *
Your answer
Medication strength (example 500mg -please write-in "not sure" if you don't know) Your prescription may be delayed as we may need to get more information on the strength. *
Your answer
Instructions on medication *
Your answer
Quantity *
Your answer
Will you be picking up the medication? Shipping is available. Shipping fees will be added to your invoice. Shipped orders need to be prepaid before going out. Please note where it is getting shipped to and attention to who. *
Your answer
How will you be paying for this medication? Payment is expected at time of pick up or before being shipped. *
How quickly do you need your medication? *
When and who will you pick up your medication? *
Your answer
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