Payment accepted by check, cash and these credit cards:

PRESCRIPTION REQUESTS BY EMAIL

For your convenience, we give you the option of refilling prescriptions for your pets online or via telephone.

Please read the following policies regarding refills before making your request:

• Your pet must have been examined by one of Cedarburg Veterinary Clinic’s doctors within the last 12 months.
• Online prescription requests are only available Monday through Friday. If prescriptions are requested after 1:00pm on Friday, the prescription will be available for pick up the following Monday at 9:00am.
• Same day requests must be completed by 1:00pm. Please allow 2 hours for your request to be processed. Prescriptions requested after 1:00pm will not be ready until 9:00am the following weekday.
• Prescriptions must have been previously prescribed by a Cedarburg Veterinary Clinic doctor.
• If a prescription is needed immediately, please call the clinic to make your request.

Note: Not all prescriptions drugs are guaranteed to be available upon request. The clinic will call you if your request cannot be granted.

Please fill out information completely:

CONTACT INFORMATION
Client First Name:
Client Last Name:
Patient Name:

Telephone number where you can be reached:
Alternate telephone number:

MEDICATION REQUESTED
Medication Name:

Additional Comments:

Amount :		Packaging:	Select One Tablet(s) Capsule(s) Bottle(s) Tube(s)

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