Prescription Refills

prescription refills

* Indicates required field

Name *

First

Last

Email *

Phone Number for Questions/Payment *

Pet's Name *

Name of Medication(s) *

Medication Strength(s) *

example: Apoquel 16 mg

Quantity Requested *

how many pills/bottles would you like?

Antigen Refills - Select One *

Molds Only Vial 2 Only Molds and Vial 2

Do you Need Allergen Syringes? *

Yes No

Do You Need a Sharps Container? *

Yes No

Would you like to pick up the medication or have it shipped? *

Pick up at AADCI office Ship to home address (shipping fees will apply) Other (enter in Comment section below)

Comment/Address for Shipping *

enter address for shipping or specific instructions for "other"

Payment Method if Shipping *

Use my card on file Please call me for payment Please send me a link to pay online I will pay when I pick up

Enter Last 4 digits *

Enter the last 4 digits of the card on file for payment

Submit

Monday: 9am-5pm Tuesday: 9am-5pm Wednesday: 9am-5pm Thursday: 9am-5pm Friday: 9am-noon Sat/Sun: CLOSED