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Prescription Refill Request

NOTE: If you need a prescription filled as soon as possible, please call our office at (508) 995-9935. This form SHOULD NOT be used for emergencies.

Please allow 1-2 days for your prescription to be filled. Add an additional 3-5 days for delivery if you are receiving it in the mail. When we receive your request, we will send you an email letting you know that the request is being processed. When your prescription is filled, we will call to let you know.

Terms of Use

By agreeing to the terms of our secure forms, you will enter a secure area of our web site. Chase Farm Veterinary Hospital will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personal identifying information is encrypted and your message will not be internally or externally forwarded to other third parties. The information will solely be used by Chase Farm Veterinary Hospital.

Your request will be processed within 24 hours, during normal business hours, Monday - Thursday, 7:30 AM - 7:00 PM, Friday, 7:30 AM - 6:00 PM, Saturday, 8:00 AM - 2:00 PM, excluding holidays. If you do not accept the terms of this disclaimer, you will not be able to process your request on-line.

If you have any questions regarding the use of these forms, please contact our office during normal business hours.

Personal Information
Your Name*
First Last
Pet's Name*
Phone or Cell Number*
Email*
Medication(s) to be Refilled
First Medicine Name (for example "Rimadyl")*
Medicine Strength (for example "100mg" or "250mg/ml")*
Please enter a number from 0 to 500.
(mg)
Dosage: How many tablets (or mls) do you give and how many times per day?*
Quantity of Medication (number of pills or mls) Requested*
Please enter a number greater than or equal to 0.
Medication(s) to be Refilled
SECOND Medicine Name
Medicine Strength (for example "100mg" or "250mg/ml"
Please enter a number from 0 to 500.
(mg)
Dosage: How many tablets (or mls) do you give and how many times per day?
Quantity of Medication (number of pills or mls) Requested
Please enter a number greater than or equal to 0.
Medication(s) to be Refilled
THIRD Medicine Name
Medicine Strength (for example "100mg" or "250mg/ml")
Please enter a number from 0 to 500.
(mg)
Dosage: How many tablets (or mls) do you give and how many times per day?
Other Information
Comments
How would you like to receive your medicine?*
- I will pick up the prescription at the hospital.
- I would like my prescription mailed to me (for an additional $8 fee)
How is your pet's health? Is your pet eating and drinking normally?*
- YES
- No
Has your pet had any vomitting or diarrhea recently?*
- Yes
- No
Is there any other information you would like to share?
Phone
This field is for validation purposes and should be left unchanged.

Prescription Refill Request

Terms of Use

Personal Information

Medication(s) to be Refilled

Medication(s) to be Refilled

Medication(s) to be Refilled

Other Information