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Prescription Refills
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Please allow 48 hours for this request to be processed
Thank you!
*
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
Home
Prescription Refills
Meet the Team!
Client Forms
Online Pharmacy
Referring Veterinarians
rDVM Consultation Request
Contact
Client Resources
COVID-19 Update