First Name:
Last Name:
Pet's Name:
Home Phone # :
EMail:
Would you like your prescription mailed to you?
Please note: A shipping and handling fee will be added to your order.
Please Choose Your Veterinarian:


Prescription Request
Medication Requested
Dosage Size / Strength
Quantity Requested
Name:
Name:
Name:
Name:
If your pet is taking medication for a chronic problem, please check the Medication Chart for special information or testing recommendations.

Phone number we can reach you at if we have a problem filling your prescription:
Comments

* On-line refill requests are processed Monday through Friday. Requests received on the weekend will be processed the following Monday.

The refill form is for the convenience of our clients that have previously been given a medication by one of our veterinarians. The prescribing veterinarian will review the request, and you will be contacted if it cannot be filled for some reason. An email confirmation will be sent for filled requests.

Federal and State laws, as well as good medical practice, prohibit us from dispensing prescription medications without prior examination of your animal (within the last 12 months), and current knowledge of your animal's health.

We are similarly prohibited from dispensing or refilling medications that were originally ordered by another veterinarian. We will be happy to dispense any needed medications after examining your pet.

 
Julington Creek Animal Hospital • 12075-100 San Jose Boulevard • Jacksonville, Florida 32223 • ph. (904) 268-6731 • fax (904) 262-2870 • email: sysadmin@jcaw.com
Hours of operation: Monday to Friday 7.30am - 6pm, Saturday 8.30 - 1.00. Doctors see patients Monday to Friday 9am-11.30am / 2pm-5.30pm, Saturday 9am - 12.30pm.

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