Medication Refill Request Form

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SPCA Veterinary Care Center - for existing clients only.

Client's First and Last Name: *

Phone Number: *

Email Address:

Pet's Name *

Pet's Species: *

Cat

Dog

Other:

Medication(s) Requested: *

If flea/tick medication is requested, how many months are needed?

If heartworm prevention* is requested, how many months are needed?

*Heartworm prevention can only be dispensed within a 12-month period after your pet has tested negative at this facility, and if your pet has been continually on prevention. We require yearly testing to provide heartworm medication.

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