Prescription Refill Form

Please complete the following form to request a prescription refill.

Client/Owner First name*

Last name*

Email address*

Best phone to contact you*

Pet's name*

I would like to:*

Pick up the medication(s) at hospital
Have the medication(s) called into a pharmacy (please confirm with your pharmacy there are no available refills before submitting this form)
Receive a written prescription by mail or pick it up in person

If from an outside pharmacy, please provide name and phone number of pharmacy below:

Name of veterinarian who prescribed the medication(s):*

Please list all medications that need to be refilled and how many doses of each you have left:*

Additional comments:

By submitting this form, you agree to the following: It is your responsibility to notify the office in a timely manner when refills are necessary. Approval of your refill may take up to three business days. Please do not wait to notify our team. Refills can only be authorized on medication prescribed by providers from our office. We will not refill medications prescribed by other providers. It is important to keep your pet's scheduled appointment(s) to ensure that you receive timely refills. Repeated no-shows or cancellations will result in a denial of refills. Medications cannot be refilled if the pet has not been seen at Lakeshore Veterinary Specialists in the last year.

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Prescription Refill - Port Washington

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