Online Form:
1) To submit the referral online, complete the following form.
Once complete, click the "Submit" button at the bottom.
2) To print your submitted form, hit the back button on your browser
once you get to the confirmation screen to get back to your form.
Then click the print button at the bottom of the page. Only visible content on that page will be printed.
Paper Form:
If you would like to print out a pdf version of the
prescription refill request form, click here. Complete the form and
fax back to (210) 930-8040.
Prescription Refill Request Form
Owner's Name:
Pet's Name:
Client's phone #
Client's alternate phone #
STVS Doctor Name:
Prescriptions Requested:
1:
2:
3:
4:
How is the pet doing?
Does Rx need to be called in to a Pharmacy?
If yes, the Pharmacy phone #
Will owner pick up the Rx?
If yes, what time
Does Rx need to be mailed to client?
Payment must be received before we can mail out your refill. Call us to pay by phone (210) 930-8383. Applicable shipping charges will be included.
If yes, what is the mailing address?