Repeat Prescriptions

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

CORONAVIRUS EMERGENCY ARRANGEMENTS

In order to keep you and our staff safe, please do not come to the surgery.

We are providing free home delivery or posting prescriptions.

A receptionist will contact you to make payment over the phone.

Many thanks for your kind understanding at this difficult time.

Contact Details

Your Name (required)

Your Address (required)

Post Code (required)

Phone Number (required)

Your Email

Species

CatDogOther

If other, please name type eg rabbit, parrot etc

Name Of Pet


Medication 1 - Name

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


Medication 2 - Name

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


Medication 3 - Name

Quantity / Number of tablets (required) 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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