Request a Medication Refill Prescription Refill Request Form Name * Name First First Last Last Email * Phone * Preferred Contact Method * PhoneEmail Pet's Name * Medication to Refill * Medication Strength * Quantity * Current Dosing Instructions * Are you out of the medication? * YesNo Comments Please give 24hrs for refills to be completed. If needed sooner, please call 919-488-5300 Requests will be filled at Companion Animal Hospital ONLY. If you need medication called into an outside pharmacy, please call 919-488-5300 Refill requests are only for existing patients that have already been prescribed the medication New medication requests require exam Heartworm medication requests require a Heartworm test within the previous year All refills require that the patient be up-to-date on annual examinations in order to maintain the veterinary-client-patient relationship (VCPR) Captcha If you are human, leave this field blank. Submit
