Prescription Refill and Food Order Request Form

Please use the form below to request your prescription refill or food item. This will save you time when picking up your order. Please allow 24 hours for order processing. Do not come to the clinic until you have received confirmation to pick up your order.

Note: Some prescriptions will require an examination of your pet prior to re-filling.

Many prescriptions require your pet to be examined before dispensing. This ensures that your pet is healthy enough to handle the potential side effects of some prescriptions and provides further confirmation that the medication is appropriate for your pet’s current condition.

IMPORTANT: Prescription Refills and Food Orders are not confirmed until you have received notification. A staff member will contact you by phone or email.

Name*
First Last
Email*
Phone*
Pet Name*
Drug or Food Name*
Dosage/Size/Strength*
Quantity*
Additional Comments*

Monday	9:00am – 7:00pm
Tuesday	9:00am – 7:00pm
Wednesday	9:00am – 7:00pm
Thursday	9:00am – 7:00pm
Friday	9:00am – 7:00pm
Saturday	9:00am – 5:00pm
Sunday	12:00pm – 5:00pm

Heartland Pet Hospital

Prescription Refill and Food Order Request Form