Patient Refill Request Form Please complete all of the following information as it will allow our staff to pull your pet's records and verify against your request, ensuring that your pet receives the most appropriate medication, food, or prevention products. 24 Hour RequirementWe do require 24 hours to review and fulfill your request(s) for medication, food, or prevention products. We appreciate your understanding!Client InformationName* First Last Phone*Email* Patient Name*Date of last lab work (if known): Medication and Dosage InformationPlease try to be as specific as possible in this section as the doctor and medical staff will be reviewing the request based on the dosages you indicate you are providing the pet. Medication Name*Dosage Given (ie. grams, milligrams, etc,...)*Amount of medication currently left?*Frequency (How often are you dispensing to your pet? Every 24 hours, every 12 hours, etc.)*Quanity Requested*How would you like your request filled?*I wish to have my request filled on-site at the hospitalI prefer to have a written scriptHow is the pet doing on the medication?*Refills from Outside ClinicsPlease understand that the state of Florida and the AVMA (American Veterinary Medical Association) guidelines prevent us from functioning as a 'pharmacy'. Additionally, they require that a doctor-client-patient relationship exist with our practice, and as such, we cannot refill or dispense medications without having seen your pet at our hospital within the last year for an examination.