Double A Veterinary Hospital

106 Nott Street
Wethersfield, CT 06109

(860)529-0668

www.doubleavet.com

Prescription Refills

You can now request a refill for your pet's prescription online by submitting the form below. The refill must be approved by the doctor. It is important that you fill in all required information. Please allow one full business day to process your request. Please see our hours of operation. If there are any problems with refilling the prescription, we will contact you via phone using numbers you provide on the form. If this is an EMERGENCY or you need faster service, please call our office. We will also contact you if you choose to have the prescription mailed to you. At that time, we will inform you of the total cost of your pet's prescription and will request a credit card number for payment. We provide FREE SHIPPINGon all heartworm medication and flea control products. For all other shipped items, there is a $8.00 mailing charge.

Controlled medications cannot be shipped by mail. These drugs can only be picked up in person.

Rx Refills Form

Name (required)

First Name (required)	Last Name (required)

Address (required)
Street Address (required)

City (required) ,	State / Province (required)	Zip / Postal Code (required)

E-Mail Address (required) :

Home Phone Number (required)

Daytime phone number
Phone Type	Phone Number

Pet's Name (required)

Species (required)

Canine
Feline
Other

Pick up Rx at the hospital

Mail Rx to home address

Prescription #1 (Please list name of the medication and quantity) (required)

Prescription #2 (Please list name of the medication and quantity)

Prescription #3 (Please list name of the medication and quantity)

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