Medication Refill Request Form

All medication requests are reviewed by a veterinarian during normal business hours. We will contact you to confirm the request as quickly as possible. Please remember to submit your request at least a few days prior to the end of your pet’s medication supply, and generally allow 24 hours for a response.

If a response is not received within your required time period, please call us directly at (304) 594-1124.

Please be aware that the medication requested can NOT be filled until a veterinarian has approved it. Many medications require that the pet have regular blood work screens or check-ups, so this may be required prior to refilling the medication.

All patients must have a medical relationship with one of our veterinarians. It is unlawful to dispense medication to a pet whom we have not examined within the past year.

Please fill out all of the required information below, one form per pet.

Client Information






Pet Information



Please leave this field empty.
If "other," please specify in comments section.


Medication Information

First Medication:





Second Medication:





Third Medication: