East Lincoln Animal Hospital

7555 Highway 73 East
Denver, NC 28037

(704)827-5300

eastlincolnanimal.com

Prescription Refill Request

In our ongoing effort to make your pet's health care as convenient and easy as possible, you can now request a refill for your pet's prescription by submitting the following form. Please be sure to fill in all the requested information. (***Please do not provide prescription numbers but list by name the medications you need refilled.***)

The prescription refill must be approved by a doctor.

We will notify you via email or phone when your pet's prescription is approved and ready to be picked up. If you would prefer to have the prescription mailed to you, please mention this information in the additional information area. If you would like the product(s) mailed, we will call you for a credit card number. (Please make sure you have left us a phone number where we may reach you). A minimal postage fee will apply.

We are only able to ship to current clients. We are required by NC State Law to have a current client/patient/veterinary relationship to fill or refill prescription medications.

If we have any questions, we will contact you by phone (please leave a number where you can be reached).

 

Prescription Refills Online

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) :
Daytime Phone
Phone TypePhone Number
Evening Phone (required)
Phone TypePhone Number (required)
Pet's Name (required)

Sex (required)
Male
Female


Age: Years, Months

Have we seen your pet within the last year? (required)
Yes
No


Medication Requested (required)

Additional Comments / Questions


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