Repeat Prescriptions

Please use this form to request a repeat prescription for your pet.

    Contact Details

    Your Name (required)

    Your Address (required)

    Post Code(required)

    Phone Number (required)

    Your Email (required)

    Species (required)

    CatDogOther

    If other, please name type eg rabbit, parrot etc

    Name Of Pet (required)


    Medication 1 - Name (required) NB subject to vets approval

    Quantity / Number of tablets (required) NB subject to vets approval


    Medication 2 - Name

    Quantity / Number of tablets NB subject to vets approval


    Medication 3 - Name

    Quantity / Number of tablets NB subject to vets approval


    I Would Like To Collect The Prescription From

    Please indicate your preferred collection location using the buttons below.

    ChorleyLeylandCoppull

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