Type of request: *

Your first name and last name or business name *

Email address *

Phone number on your account *

Name of animal *

Name of medication *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.

What is the concentration of this medication?

This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.

Quantity of this medication requested *

How often is your animal getting this medication? *

How much of this medication is your animal getting per dose? *

How is your animal doing on this medication? *

Add another prescription refill *

Yes
No

Name of medication *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.

What is the concentration of this medication?

This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.

Quantity of this medication requested *

How often is your animal getting this medication? *

How much of this medication is your animal getting per dose? *

How's your pet doing on the current dosage? *

Add another prescription refill

Yes
No

Name of medication *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.

What is the concentration of this medication?

This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.

Quantity of this medication requested *

How often is your animal getting this medication? *

How much of this medication is your animal getting per dose? *

How's your pet doing on the current dosage? *

Add another prescription refill

Yes
No

Name of medication *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.

What is the concentration of this medication?

This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.

Quantity of this medication requested *

How often is your animal getting this medication? *

How much of this medication is your animal getting per dose? *

How's your pet doing on the current dosage? *

Add another prescription refill

Yes
No

Name of medication *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container below and indicate here that you have.

What is the concentration of this medication?

This will commonly be indicated by mg, or mg/ml on the label. If you are unsure, you can include a photo of your current medication container and indicate here that you have.

How much of this medication is your animal getting per dose? *

How often is your animal getting this medication? *

How much of this medication is your animal getting per dose? *

How's your pet doing on the current dosage? *

Do you want this prescription to be written & faxed to a different pharmacy to be filled? *

Yes
No

Where would you like this prescription faxed? *

Additional Notes:

Photo of medication or coupon

Click or drag a file to this area to upload.

Food/Supplement/Retail Item Order

Name of food/supplement/retail item *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current food, supplement or retail item below and indicate here that you have. Please include the brand and name of products whenever possible. If this is a food item, please include type (ie. pate, stew, kibble, etc) and flavour.

Size of food, supplement or retail item *

For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1

Quantity of above-mentioned size *

Add another item

Yes
No

Name of food/supplement/retail item *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current food, supplement or retail item below and indicate here that you have. Please include the brand and name of products whenever possible. If this is a food item, please include type (ie. pate, stew, kibble, etc) and flavour.

Size of food, supplement or retail item *

For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1

Quantity of above-mentioned size *

Add another item

Yes
No

Name of food/supplement/retail item *

Size of food, supplement or retail item *

For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1

Quantity of above-mentioned size *

Add another item

Yes
No

Name of food/supplement/retail item *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container and indicate here that you have

Size of food, supplement or retail item *

For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1

Quantity of above-mentioned size *

Add another item

Yes
No

Name of food/supplement/retail item *

If you are unsure how to spell it, please spell how it sounds or include a photo of your current medication container and indicate here that you have

Size *

For food items, please include the weight. For retail items, please include weight or quantity in a package if applicable. If item is one-size, such as a toothbrush, please enter 1

Quantity of above-mentioned size *

Photo of product or coupon

Click or drag a file to this area to upload.

How would you like to be contacted when your order is ready? *

Text cell number on file
Phone call number on file
Email address on file
Number/email not on file

Number/email not on file *

Are you located within Westmoreland, TN and would you be interested in delivery for a small fee? *

Yes
No

Our local delivery fee is $10.50 (plus tax), or is complimentary if receiving mobile services.

**Payment for the total is required prior to sending items out for delivery. Upon receipt of payment, items will be delivered on the next scheduled mobile day (Wednesdays starting February 7th, 2024).

Are you located within Westmoreland, TN and would you be interested in delivery for a small fee? *

Yes
No

Our third party MEDDs delivery fee is $10.50 (plus tax).

View a map of our current delivery area

**Payment for the total is required prior to sending items out for delivery. Upon receipt of payment, items will be delivered in 2-3 business days.

Special notes to assist with a smooth delivery

Please confirm physical delivery address *

Address Line 1

Address Line 2

City

State

Zip Code

Is this your current address? *

This is my current home address. If it does not match what is on file, you may update it to this.
This is a one-time address for delivery only

Please confirm physical delivery address *

Address Line 1

Address Line 2

City

State

Zip Code

Is this your current address? *

This is my current home address. If it does not match what is on file, you may update it to this.
This is a one-time address for delivery only

Additional Notes

**Please note that 1-2 business days' notice is required for prescription refills. Compounded pharmacy items and items that are not normally stocked may take longer (5-10 business days).**

**Please note that 2-5 business days' notice is required for food, supplement or retail item orders.**

Refill Request Form

Refill Request Form

Food/Supplement/Retail Item Order

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